腰椎管术后并发无致压因素剧烈坐骨神经痛的剖析

Analysis of concurrent severe sciatica without pressure cause following lumbar spinal surgery

目的探讨腰椎管手术后短期内出现无椎管内致压因素的剧烈坐骨神经痛的原因,为处理提供思路。方法对2004-10-2011-08月腰椎术后短期内发生剧烈坐骨神经痛的12例患者的病情特点及治疗进行回顾,分析产生症状的可能因素,评价处置措施的有效性。结果 12例中男3例,女9例,2例术后麻醉消失数小时后发作,其他为术后1～2 d发作,呈现撕裂样、刀割样下肢串痛,单纯患肢痛10例,单纯健肢痛1例,伴有健肢痛1例。治疗过程中未发现手术节段有任何致压物。镇静、消炎、脱水、神经营养神经治疗后,全部在住院期间症状消失,病情最长1月,随访半年～2年,未见症状复现。结论体质因素、节段性无菌性神经根周围炎、根致敏及患根病理环境的突然改变造成的根反应为其突发疼痛的因素。

Objective To explore the reasons of concurrent severe sciatica without pressure cause following lumbar spinal surgery in a short term,to provide ideas for processing. Methods The pa- tient characteristics and treatment of 12 cases of concurrent severe sciatica following lumbar spinal surgery shortly which appeared between October 2004 to August 2011 lumbar are reviewed, ana- lyze the possible factors,and evaluate the effectiveness of treatment measures. Results The males in 12 cases are 3 cases, females are 9 cases,2 cases broke out after anesthesia disappear hours lat- ter, the others for 1-2 days after the operations,presented lower limb pain just like which were toredor were cut by knife, pure sick limb pain are 10 cases,only healthy limb pain in 1,1 ease of sick limb pain with healthy limb. Nothing had been found to pressure roots during the healing process. Calm.diminish inflammation, dehydration,nourish nerve and so on,all patients get rid of their pain during staying be in hospital, the longest condition lasted 1 month,follow-up half year- 2 years, did not see the repetition symptoms. Conclusion The physique factors, segmental aseptic inflammation around nerve root, root sensitization and root reaction caused by the sudden change of roots pathological environment and so on may be the reasons which lead to their emergency response sciatica.