腰神经根管狭窄症的临床特征

Clinical Manifestation of Lumbar Nerve Root Canal Stenosis

目的 总结腰神经根管狭窄症的临床特点、诊断要点及有关发病因素。方法 对经手术证实的 18例腰神经根管狭窄症的临床表现、影像学特征、手术方式进行回顾性分析总结。结果 L5根管狭窄 12例 ,S1根管狭窄 6例 ,体力劳动者 12例。病程一年以上 14例 ,单侧根痛性间歇性跛行 17例 ,向患侧的弯腰屈髋行走步态 14例 ,直腿抬高试验阴性 15例 ,反直腿抬高试验阳性并加强试验阳性 15例 ,腰骶部叩击痛伸直位 (+)弯腰位 (- ) 14例 ,坐骨神经功能下降者 13例。CT提示椎间隙及椎体上缘平面侧隐窝狭窄 14例 ,椎弓根及其下缘平面根管狭窄 4例。 18例行扩大开窗根管减压术。随访半年～ 5年 ,优 14例 ,良 4例。结论 ①单侧根痛性间歇性跛行 ;向患侧的弯腰屈髋行走步态 ;直腿抬高试验阴性 ;反直腿抬高试验阳性并加强试验阳性 ;腰骶部叩击痛弯腰位 (- )伸直位 (+)是该病的五大临床特点。②椎间盘 ,椎弓根及下缘平面的CT或CTM是该病最有价值的诊断手段。

Objective To summarize the clinical manifestation and diagnosis of lumbar nerve root canal stenosis and discuss its ralated pathogenic factors.Methods Eighteen cases of lumbar nerve root canal stenosis undergone surgical treatment were reviewed.Results The distribution of nerve root canal stenosis was L 5 in 12 and S 1 in 6.Fourteen cases excess 1 year in history,17 cases had intermittent claudication of root pain of oneside,15 cases had position sign during the straight leg raising test and 15 cases had position sign during opposite straight leg raising test.Fourteen cases had percussive pain of lumbar-sacral when lowing lumbar.Thirteen cases had lowed in the function of sciatic nerve.CT Showed 14 cases had lateral recess stenosis in the level of intervertebral discs and up-edge of vertebral and 4 cases had root canal stenosis in the level of pedicle and under-edge of pedicle.Eighteen cases were treated with oneside opening window plus decompression of root canal.Eighteen cases were followed-up for 0.5-5 years.Fourteen cases were excellent and 4 cases were good.Conclusion 1.There are intermittent claudication of root pain of oneside the negative straight leg raising test,in opposite stranght leg positive raising test and percussive pain of lumbar-sacral when lowing lumbar were clinical manifestation.2.CT scanning level of intervertebral discs and pedicle and under edge of pedicle is valuable dignosis method.3.oneside opening window plus decompressing root canal are effective surgical approach.