腰椎间盘突出症合并马尾神经损伤的临床特点

Lumbar disc herniation combined with cauda equina syndrome

目的 探讨腰椎间盘突出症合并马尾神经损伤的发病机制、诱因、病理、诊断及手术等。方法 对 37例腰椎间盘突出症合并马尾神经损伤患者的临床表现、影像学特征及手术情况进行分析。结果 平均随访 3.5年。腰背痛伴间歇性跛行、下肢肌肉瘫痪、马尾神经功能完全恢复 8例 ,部分恢复 2 5例 ,无改变 4例。结论 早期诊断、早期手术是括约肌功能及马鞍区症状恢复的关键。诊断主要依靠临床表现及椎管造影 +CTM。腰椎管减压及腰椎间盘摘除必须考虑脊柱的稳定性。马尾神经功能恢复取决于病理类型。

Objectives To investigate the pathogenesis,predisposing factors,pathology,diagnosis and surgical intervention of the lumber disc herniation with syndrome of cauda equina injury.Methods 37cases of lumbar disc herniation with syndrome of cauda equina injury were reported.Results The following up 3.5years on the average. The backache with sciatica,the muscular paralysis of the lower limb and function of the cauda equina were fully recovered in 8,in 25 respectively,and unchanged in 4.Conclusions The earlier diagnosis and surgical treatment are performed ,the better result of sphincter control muscle power and saddle sensory may be received. The diagnosis of this disease depends upon clinical manifestation and lumbar myelography+CTM examination.When most patients were undergone decompression of lumbar canal and excision of herniated disc, the spinal stability should be concerned. The prognosis of the disease has related to the cauda equina injured and related to the size and velocity of the protrusion.