腰椎间盘突出合并腰骶神经后根节嵌压(附9例报告)

Lumbar disc herniation with entrapent of lumbar-sacral dorsal root ganglia

目的 :了解腰椎间盘突出合并腰骶神经后根节 (DRG)嵌压机理。方法 :9例发现髓核切除术后神经根张力仍较大 ,沿神经根探查 ,发现腰骶神经背根节受嵌压 ,充血肿大 ,嵌压物为增生的关节炎和肥厚的关节囊韧带 ,共查 10个DRG ,合并神经根异常 (NRA) 3例。结果 :随访 0 .5～ 3.5年 ,平均1.5年。优 5例 ,腰腿痛完全缓解 ,恢复原来工作 ,良 3例 ,劳累后轻度腰痛 ,可 1例 ,仍有轻度腰腿涌 ,下肢肌力减弱。结论 :腰椎间关节及间盘退变引起关节突增生 ,关节囊韧带增生肥厚导致侧隐窝和椎间孔狭窄 ,腰骶神经根变异 ,DRG位置相对内移并受嵌压是产生腰腿痛的主要原因 ,神经根及DRG变异畸形属先天性发育异常 ,并非是造成临床症状的直接因素 ,而是发病的病理基础。

Objective: To understand the mechanism on lumbar disc herniation (LDH)with entrapment of Lumbar-sacral dorsal root ganglia (DRG). Methods: Nine cases with LDH were operated for disectomy. On operation the nerve roots had more tension, eren after the discs were removed. Examining along the nerve roots, the DRGs were found congestion and swelling for entrapment by the hyperplasia and hypertrophy of atricular process and capsular ligament. There were 10 DRGs and 3 cases of nerve-root anomalism (NRA) in all. Results: All the patients after surgery were followed up for 0.5～3.5 years(mean,1.5) 5 patients were completely relived of the lumbago and sciacica, 3 had a slight lumbago only after overwork. 1 possessed the slight lumbago and sciatica with the muscle strength of lower limbs weadened. Conclusion: Degenerative change of lumbar disc and intervertebral articular cause the hypreplasia and hypertrophy of articular process and capsular ligament as well as intervertebral foramen stenosis and lateral recess canal stenosis. The internal movenent and entrapment of DRGs become the main teasons for the lumbago and sciatica. The nerve root and DRGs with ectopicdeformity belong to an inborn developed error. It's not the direct etiologic factor of the clinical symptom but the pathological basis of the disease.