L5S1椎间盘突出症合并骶管内囊肿20例报告

临床上，腰椎间盘突出症合并椎管内囊肿的病例是较为少见的。本文就作者近年内收治的L5S1椎间盘突出症合并骶椎管内囊肿病人的诊断特点、手术指征以及术式等问题进行分析探讨。     

腰椎间盘突出症患者突出椎间盘及相邻椎间盘退变程度的MRI分析

目的:分析腰椎间盘突出症患者突出椎间盘及相邻椎间盘的术前MRI表现,评估其退变程度。方法:回顾性分析2014年6月~2015年12月在宁夏医科大学总医院脊柱骨科已行手术治疗的的单节段腰椎间盘突出症患者100例,其中男56例,女44例,年龄23~79岁(51.68±5.60岁),将所有患者以10年为一年龄段进行分组。突出椎间盘发生在L4/5节段50个,其相邻椎间盘100个;L5/S1节段50个,其相邻椎间盘50个。观察术前腰椎MRI,椎间盘采用Pfirrmann分级标准进行评估;软骨终板形态以Pappou分级标准进行评估。年龄段间的比较采用单因素方差分析,相邻椎间盘与退变椎间盘间的相关性采用Pearson相关分析,相邻椎间盘间的比较采用t检验。结果:各年龄段L4/5、L5/S1突出椎间盘的Pfirrmann分级均在Ⅲ级以上、Pappou分级均在Ⅱ级以上,各年龄段间椎间盘退变结果有统计学差异(P0.05);而各年龄段间软骨终板退变结果无统计学差异(P0.05)。各年龄段间突出椎间盘发生在L4/5、L5/S1的上位相邻椎间盘Pfirrmann分级有统计学差异(P0.05),下位相邻椎间盘Pfirrmann分级各年龄段无统计学差异(P0.05),相邻椎间盘软骨终板退变结果各年龄段间无统计学差异(P0.05)。相邻的L3/4椎间盘Pfirrmann分级与突出的L4/5椎间盘Pfirrmann分级有相关性(r=0.696,P=0.000),相邻L5/S1椎间盘Pfirrmann分级与突出L4/5椎间盘Pfirrmann分级间无相关性(r=0.214,P=0.136);相邻的L3/4、L5/S1椎间盘软骨终板形态Pappou分级与突出的L4/5椎间盘软骨终板形态Pappou分级均有相关性(r=0.467,P=0.001;r=0.380,P=0.007)。相邻L4/5椎间盘的Pfirrmann分级与突出L5/S1椎间盘的Pfirrmann分级有相关性(r=0.549,P=0.000);相邻L4/5椎间盘软骨终板形态Pappou分级与突出L5/S1椎间盘的软骨终板形态Pappou分级有相关性(r=0.684,P=0.001)。L4/5椎间盘突出的相邻L3/4椎间盘Pfirrmann分级和软骨终板形态Pappou分级评分分别为3.26±0.87分、1.54±0.50分,均高于相邻L5/S1椎间盘的2.96±0.59分、1.23±0.49分(P0.05)。结论:腰椎间盘突出症患者突出节段的相邻椎间盘及软骨终板的退变与年龄及突出椎间盘退变程度关系密切,且相邻上位椎间盘较下位椎间盘退变更明显。     

短节段椎弓根钉内固定加植骨融合治疗腰椎间盘突出症并腰椎不稳

笔者自2006年1月～2009年1月采用短节段椎弓根钉内固定加单侧小开窗椎间及对侧椎板植骨融合治疗38例腰椎间盘突出并腰椎不稳,取得良好的较果.1临床资料1.1一般资料本组38例,男25例,女13例;年龄38～65,平均45岁.L3、4椎间盘突出2例,L4、5椎间盘突出16例,L5S1椎间盘突出13例,L4、5及L5S1椎间盘同时突出7例.单节段不稳29例(L3、4 2例,L4、5 14例,L5S1 13例);多节段不稳9例(L3、4、L4、52例,L4、5、L5S1 7例).患者均有不同程度腰腿痛症状,经1～2次正规非手术治疗无效.诊断依据:①腰腿痛症状;②体位改变时腰痛症状加重;③CT、MRI检查证实腰椎间盘突出;④腰椎过伸过屈位X线片示腰椎椎体间相对水平前后滑移超过3 mm[1].所有患者符合上述4个标准.     

青壮年腰椎间盘突出症椎间盘镜微创术疗效分析

目的探讨采用椎间盘镜治疗青壮年腰椎间盘突出症临床疗效与椎间盘突出类型和突出节段的相关性。方法对青壮年腰椎间盘突出症46例采用椎间盘镜微创术治疗。结果末次随访时85.4%(35/41)重新返回工作岗位,14.6%(6/41)带药出院。VAS评分平均减少4.7分。结论采用椎间盘镜治疗青壮年症状性椎间盘突出,具有创伤小、恢复快的特点,应用于L5S1间盘突出时疗效更好。     

后路螺纹式Cage植骨治疗退变性腰椎间盘病变

目的　通过后路螺纹式Cage植骨治疗退变性腰椎间盘病变 ,探讨其治疗机制与手术效果。 方法　后路螺纹式Cage植骨治疗 2 2例退变性腰椎间盘病变患者。L4、5椎间盘病变 13例 ,其中L4、5椎间行TFC植骨 ,同时伴有L5S1椎间盘突出 ,又行L5S1椎间盘摘除术者 4例 ;L5S1椎间盘病变 9例 ,其中L5S1椎间行TFC植骨 ,同时伴有L4、5椎间盘突出 ,又行L4、5椎间盘摘除术者 2例。有 8例病人有Ⅰ度椎体滑脱 ,同时行后路椎弓根钉内固定术。结果　本组病例随访 2～ 2 1个月 ,平均 11 5个月。按Nakai标准评定疗效 :优 2 0例 ,占 90 9% ;良 2例 ,占 9 1%。所有病人术后半年均已见植骨融合 ,Cage无移位 ,椎间隙无塌陷。结论　后路螺纹式Cage植骨能有效地撑开或保持受累椎间隙、扩大椎间孔、提供术后即刻稳定性 ,并可固定移植骨 ,骨融合可靠 ,是治疗退变性腰椎间盘病变最为有效的方法之一。     

改良经椎板间隙法腰椎间盘髓核摘除术52例报告

1998年7月～2001年7月采用改良经椎板间隙法腰椎间盘髓核摘除术治疗腰椎间盘突症52例，取得良好效果。报告如下。临床资料男38例，女14例，年龄19～67岁，平均36岁。均经临床、CT和/或MRI确诊。腰椎间盘突出部位：L4/524例，L5/S120例，L4/5并L5/S18例。旁侧型突出40例，中央型突出12例。13例合并侧隐窝狭窄。双侧手术8例，余均为单侧手术。从52例腰椎正侧位片上测量椎板间隙与椎间盘后缘的对应关系，椎间盘后缘中点与椎板间隙正相对者：L4/56例，L5/S119例。椎间盘后缘中点与椎板间隙上部相对者：L4/524例，L5/S18例。椎间盘后缘中…     

椎间盘镜联合射频消融术治疗多节段腰椎间盘突出症

目的探讨后路椎间盘镜(MED)联合射频消融术治疗多节段腰椎间盘突出症的疗效。方法回顾性分析2011年10月～2015年10月我院治疗的多节段(两节及两节以上)单纯腰椎间盘突出症22例患者的临床资料,其中受累椎间盘:L4/5、L5/S1 17例,L3/4、L4/5 2例,L3/4、L4/5、L5S1 3例。对主要突出节段采用后路椎间盘镜进行髓核摘除术,对次要突出节段采用射频消融术治疗:L4/5射频消融+L5S1 MED 13例,L5S1射频消融+L4/5 MED 4例,L4/5射频消融+L3/4椎间盘镜1例, L3/4射频消融+L4/5椎间盘镜1例, L3/4、 L4/5射频消融+L5S1 MED 3例。记录手术时间、术中出血量,比较手术前后腰腿痛VAS评分、JOA评分。结果本组所有患者均顺利完成手术,手术时间平均90(70～210)分,出血平均145.8(50～300)ml。所有手术切口均一期愈合,无伤口感染、血肿形成、神经损伤、硬膜囊破裂等并发症。1例患者下肢仍有中等麻痛、 2例足趾轻度麻木,其余患者基本恢复。平均随访18.2(12～27)月,无一例复发,复查MRI示消融椎间盘无退变及突出进展。术后1周和末次随访JOA评分分别为(18.0±3.11)分和(25.18±2.92)分,均较术前(9.09±0.97)分明显改善(P0.01);术后1周和末次随访VAS评分分别为(3.00±0.87)分和(2.23±0.92)分,均较术(7.86±0.94)前明显降低(P0.01)。结论对多节段腰椎间盘突出症,后路椎间盘镜联合射频消融术能即刻解除突出椎间盘导致的神经压迫,减轻邻近次要突出椎间盘的压力,减缓邻近椎间盘突出进展。     

手法为主综合治疗腰椎间盘突出手术后复发

腰椎间盘突出症所引起的腰腿痛,目前多主张以保守治疗为主,但经手术治疗的也有一定比率。自2000年10月-2005年12月共收治经手术后复发的腰椎间盘突出症19例,临床应用松肌法、分离神经根粘连法、骨盆旋转整脊法、后伸压腰法、纠正脊柱侧弯法为主,结合骨盆牵引中药熏蒸,药物对症治疗为辅,取得了满意的效果。为探究其疗效机制,现总结如下。1临床资料1.1一般资料19例中,男16例,女3例;年龄26~59岁。有劳损、外伤及受凉诱发者12例。发病部位据CT、MRI检查统计:L3,4椎间盘突出1例,L4,5椎间盘突出9例,L5S1椎间盘突出5例,L4,5和L5S1两节段椎间盘…     

经椎板间入路完全内窥镜下椎间盘摘除术与显微内窥镜下椎间盘摘除术治疗L5/S1椎间盘突出症的比较

对保守治疗无效的腰椎间盘突出症患者,传统开放手术有确切疗效[1]。经椎板间入路完全内窥镜（full-endoscopic,FE）下椎间盘摘除术与显微内窥镜下椎间盘摘除术（microendoscopic discectomy,MED）是临床上用于治疗L5/S1椎间盘突出症较常用的微创手术方法,并获得了满意疗效[2-5]。此两种方法与传统开放手术比较均具有创伤小、术后恢复快等优点[2~5]。但这两种微创手术治疗L5/S1椎间盘突出症有何异同,目前报道较少。本研究对2010年12月~2012年5月我院采用上述两种微创手术治疗的L5/S1椎间盘突出症患者102例进行回顾性分析,比较这两种微创手术治疗L5/S1椎间盘突出症的手术创伤与临床疗效,为临床提供参考。     

髓核溶解术治疗腰间盘突出症46例

我院自2002年3月开始应用椎间盘内注入胶原酶,使突出椎间盘髓核溶解,椎间盘回缩吸收,解除神经根压迫症状,临床治疗46例,效果满意,现报告如下. 1 临床资料 本组46例中男性27例,女性19例;年龄24～58岁,平均38.5岁.其中L3～4间隙突出1例,L4～5间隙突出25例,L4～5、L5～S1间隙同时突出5例,L5～S1间隙突出15例,均有明显腰腿疼痛史,CT或磁共振均为腰椎间盘突出.其中2例有脑血栓、心脏病史.     

Congenital absence of lumbosacral articular facet joint associated with conjoined nerve root: a case report

We report a rare case of congenital absence of the L5-S1 facet joint, which was associated with a conjoined nerve root. Combination of these two anomalies has been quite rarely reported in the literature. A 39-year-old man presented with acute low back pain and right leg radiating pain. Muscle weakness and sensory disturbance of the right leg were also apparent in the region innervated by L5 and S1 nerve roots. Preoperative multidetector three-dimensional computed tomography (3D-CT) showed complete absence of the right S1 superior articular process. Magnetic resonance (MR) images showed lumbar disc herniation at right L5-S1 level that migrated cranially. Intraoperative findings revealed that the right L5 nerve root and S1 nerve root were conjoined, and the conjoined nerve root was compressed by L5-S1 disc herniation, which led to impairment of the conjoined nerve root by a single-level lumbar disc herniation. After removal of the disc herniation, his right leg pain immediately subsided, however muscle weakness and sensory disturbance persisted. Surgeons should be aware of this nerve root anomaly when examining a patient who shows an unusual clinical presentation and/or congenital osseous anomaly.     

Magnetic resonance assessment of the distribution of lumbar spine disc degenerative changes

The lumbar spine magnetic resonance (MR) studies in 246 consecutive patients who suffered from persistent back and leg pain were evaluated for the degree of degenerative disc disease and the presence of disc bulging, prolapse, or herniation. No patient had a history of previous back surgery. In those patients, degenerative disc changes increased with age until the fifth decade of life, after which a relatively similar proportion of patients had degenerative disc disease. Significant dehydration and degeneration occurred in less than 5% of the upper two disc spaces while L4/5 and L5/S1 had marked changes in greater than 20%. Prolapse and herniation progressively increased with each lower interspace, where at L5/S1 it was present in nearly one-third of the patients. Although a few patients had disc prolapse or herniation with a nondegenerated disc, there was a relationship between the presence of disc degeneration and prolapse or herniation.     

Association of facet tropism with lumbar disc herniation

Purpose

Facet tropism is defined as asymmetry between left and right facet joints and is postulated as a possible cause of disc herniation. In the present study, the authors used a 3-T MRI to investigate the association between facet tropism and lumbar disc herniation at a particular motion segment. They also examined whether the disc herniated towards the side of the more coronally oriented facet joint.

Methods

Sixty patients (18–40 years) with single level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet angles were measured using MRI of 3-T using the method described by Karacan et al. Facet tropism was defined as difference of 10° in facet joint angles between right and left sides. Normal disc adjacent to the herniated level was used as control. We also examined if disc herniated towards the side of more coronally oriented facet.

Results

Twenty-five herniations were at L4–L5 level and 35 at L5–S1. Statistical analysis was performed using the Fischer Exact Test. At L4–L5 level, 6/25 cases had tropism compared to 3/35 controls (p = 0.145). At L5–S1 level, 13/35 cases had tropism as compared to 1/21 controls (p = 0.0094). Of 19 cases having tropism, the disc had herniated towards the coronally oriented facet in six (p = 0.11).

Conclusion

The findings of the study suggest that facet tropism is associated with lumbar disc herniation at the L5–S1 motion segment but not at the L4–L5 level.     

直腿抬高试验影响因素的逐步回归分析

目的研究直腿抬高试验(straightlegraisingtest,SLR)结果与患者年龄、性别、病程、椎间盘突出率等因素之间的关系。方法对505例腰椎间盘突出病例的SLR影响因素进行逐步回归分析,男281例,女224例;年龄26~69岁,平均42.1岁。单间隙突出(L4-5或L5S1)337例,多间隙突出168例。321例行CT检查,184例行MR检查。结果SLR与急或慢性病程、椎间盘突出率、侧隐窝是否狭窄、椎间盘突出位置(中央型、侧旁型)、间歇性跛行距离等相关;而与年龄、性别、民族(汉族与维吾尔、哈萨克、回族比较)、椎间盘突出大小、单或多间隙突出、侧旁突出的根前、根腋、根肩型不相关;L4-5与L5S1椎间盘突出的SLR结果差异有非常显著性(P<0.01)。结论SLR受诸多因素影响,临床上不能将SLR结果作为判定椎间盘突出严重程度的重要指标。其相关因素为急或慢性病程、椎间盘突出率、侧隐窝是否狭窄、椎间盘突出位置及间歇性跛行距离。     

Intraradicular disc herniations in the lumbar spine and a new classification of intradural disc herniations

STUDY DESIGN: A case report of intraradicular disc herniation. Intraradicular disc herniation is a special type of intradural disc herniations. In this report, we present the tenth case of intraradicular lumbar disc herniation and suggest a new classification for intradural disc herniations. CASE REPORT: A 32-year-old male was admitted to hospital having experienced pain in the lower back and right leg for 1 month prior to admission. Neurological examination revealed weakness of the extensor hallucis longus, positive Laségue's sign, decreased ankle reflex in his right lower extremity, and bilateral paravertebral muscle spasm. Magnetic resonance imaging (MRI) revealed a disc herniation with a posterolateral extruded fragment on the right at the level of the L5-S1 space. He underwent L5 laminectomy. During the operation, the right S1 root was found to be swollen and immobile. A longitudinal incision was made in the dura of the right S1 root and an intradural free disc fragment was removed, and the S1 root was relieved. The patient was free of pain postoperatively. CONCLUSION: We suggest a new classification for intradural disc herniations with this unusual case presentation and review the literature for pathogenesis, clinical picture, diagnosis and treatment.     

Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation

Purpose

To investigate asymmetry in size and composition of the multifidus and erector spinae in patients with posterolateral disc herniation and concordant radicular symptoms, and determine whether symptom duration is associated with degree of asymmetry.

Methods

Thirty-three patients diagnosed with posterolateral disc herniation at L4–L5 verified on imaging and concordant leg pain were included. Multifidus and erector spinae cross-sectional area (CSA), functional cross-sectional area (FCSA, fat-free area), signal intensity and ratio of FCSA to total CSA were measured bilaterally from T ₂-weighted axial magnetic resonance imaging (MRI) at L3–L4, L4–L5, L5–S1 and S1 levels.

Results

No side-to-side differences in multifidus CSA, FCSA, and ratio of FCSA/CSA reached statistical significance at any spinal level. The multifidus signal intensity at L5–S1 was significantly greater (more fatty infiltration) on the side of the disc herniation. The erector spinae FCSA (lean muscle mass) at L5–S1 was found to be significantly smaller on the side of the herniation and the ratio of FCSA/CSA was smaller (more fatty infiltration) on the side of the herniation at L4–L5 and L5–S1. The degree of muscle asymmetry was not associated with symptoms duration.

Conclusions

There was no significant asymmetry of the multifidus at spinal level above, same or level below the disc herniation. Instead, variations in muscle composition were observed, with greater fat infiltration on the side and at spinal levels adjacent to the disc herniation. Muscle asymmetry was not correlated with symptom duration.

     

显微椎间盘镜下B-Twin椎间融合术治疗腰椎退变失稳型椎间盘突出症

目的探讨后路显微椎间盘镜下可膨胀性椎间融合器B-Twin植入椎间融合术治疗腰椎退变失稳型椎间盘突出症的临床疗效。方法 2005年9月~2008年6月,对32例腰椎退变失稳型椎间盘突出症行后路显微椎间盘镜联合可膨胀性椎间融合器B-Twin植入椎间融合术。手术融合节段：L2/31例,L3/43例,L4/518例,L5/S110例,均为单节段。结果植入2枚B-Twin 23例,单枚9例。术后1周VAS疼痛评分由术前8.7±0.3降至2.3±1.7（t=20.64,P=0.001）。随访时间平均25个月（24~29个月）,植骨融合率采用Suk标准：1年融合率为93.8%（30/32）,2年融合率为96.9%（31/32）,B-Twin椎间融合器无明显下沉。结论后路显微椎间盘镜联合可膨胀性椎间融合器B-Twin植入椎间融合术治疗腰椎退变失稳型椎间盘突出症创伤小,植骨融合率高,临床症状缓解满意。     

腰椎椎间盘突出症经椎板间和经椎间孔入路内镜治疗的比较研究

目的 探讨经皮内镜治疗L5/S1腰椎椎间盘突出症的入路选择。 方法 2011年8月~2012年8月符合入选条件的68例L5/S1腰椎椎间盘突出患者按入院奇偶顺序分成2组,椎板间入路组34例,椎间孔入路组34例。对2种手术入路的手术时间、透视次数、术中患者耐受情况、患者疗效满意度、术后残余症状、并发症及术前术后疼痛视觉模拟量表（visual analogue scale, VAS）评分进行比较。 结果 椎板间入路组有4例术中改为椎间孔入路,椎间孔入路组有7例改为椎板间入路,经椎板间入路和椎间孔入路手术时间分别是（50.2±7.0）min、（61.9±9.6）min（P＜0.05）,术中透视次数分别为5.4±2.3次、10.3±2.5次（P＜0.05）,2种入路治疗后腿痛术后即刻及术后3个月VAS评分与术前相比差异均有统计学意义（P＜0.05）。改良MacNab标准评定2组间差异无统计学意义（P＞0.05）。 结论 经皮内镜下治疗L5/S1腰椎椎间盘突出症经椎板间或经椎间孔入路治疗各有特点,且均能取得优良的临床疗效,但需针对患者的解剖情况、影像定位及临床表型选择适宜的个体化手术入路。     

可动式脊柱内镜技术治疗游离型腰椎间盘突出症

目的 探讨可动式脊柱内镜技术治疗游离型腰椎间盘突出症的疗效.方法 2007年5月至2009年12月,应用可动式脊柱内镜技术治疗游离型腰椎间盘突出症患者31例.男17例,女14例;年龄32～59岁,平均46岁.根据MRI判断游离髓核来自L2-3 1例,L3-4 1例,L4-5 16例,K5S1 13例;1例患者MRI椎管内阻塞信号混杂,24例髓核向尾侧游离,6例向头侧游离(其中1例游离至头侧椎弓根水平,2例游离至椎间孔内).临床症状体征与影像学表现相符合.术后随访6～24个月,平均12个月.根据Macnab标准评定疗效.结果 31例手术均顺利完成:彻底摘除游离髓核,探查硬膜囊和神经根周围无残留髓核;30例摘除相应椎间盘内变性髓核,1例纤维环"闭合"且突出不明显者未摘除椎间盘内髓核.术中发现:MRI信号混杂者髓核连同软骨终板和纤维环一起经神经根腋部游离至硬膜囊背侧;MRI示髓核向尾侧游离者15例游离至硬膜囊和神经根腹侧,5例游离至神经根腋侧与硬膜囊之间,4例经神经根腋侧游离至硬膜囊和神经根背侧;MRI示髓核向头侧游离者5例位于硬膜囊腹侧,1例游离至硬膜囊背侧到达椎弓根水平,游离至椎间孔的2例均位于发出神经根腋侧.手术时间40～70min,平均50min;术中出血30～200ml,平均80ml.均未发生神经损伤等并发症,关节突关节切除过多2例,但均未引起失稳和腰痛.疗效:优21例,良10例.结论 可动式脊柱内镜工作通道可随意移动和倾斜,视野范围大,容易探查椎管和神经根通道、彻底摘除游离髓核,是治疗游离型腰椎间盘突出症的较好方法.

Abstract：

Objective To evaluate the efficacy of mobile endospine system for sequested lumbar disc herniation.Methods From May 2007 to December 2009,31 patients of sequested lumbar disc herniation were treated with mobile endospine system,including 17 men and 14 women with a mean age of 46 years (32-59 years).Patients complained severe leg and low back pain with disability.According to MRI,the sequested nucleus herniated from the disc of L2-3 in 1 case,L3-4 in 1,L4-5 in 16 and L5S1 in 13;and the direction of herniation was caudal in 24 cases,cephalic in 6 and indistinguishable in 1.The patients were followed up for 12 months (range,6-24 months) ,and the results were evaluated according to Macnab scale.Results The procedure was technically successful in all the patients:the sequested nucleus was completely extracted.The protruded disc was treated with discectomy in 30 cases,and the nearly intact disc was left untouched in one patient.Among the 24 cases with caudal herniation,sequested nucleus situated ventrally beneath the dural theca and the transitional nerve root in 15 cases,between the nerve root and dural theca in 5,and dorsally on the nerve root and dural theca in 4.All the 6 cephalic herniation situated beneath the dural theca,1 of them reached the level of pedicle,and 2 herniated into the intervertebral canal.The sequested disc presented as indistinguishable signal on MRI included nucleus,annulus and cartilage endplate,and situated dorsally around the dural theca.The mean operative time was 50 min (range,40-70 min) with a mean blood loss of 80 ml (range,30-200 ml).There was no complication of nerve injury.Only too much facet was resected in 2 patients without clinical symptom.The results were excellent in 21 cases and good in 10 cases,and all of them were satisfied with this procedure.Conclusion The working canal and visual field of mobile endospine system is movable,so the sequested nucleus can be extracted completely with good results.     

皮节体感诱发电位在腰椎间盘突出症中的诊断作用

目的 探讨皮节体感诱发电位（ＤＳＥＰ）在腰椎间盘突出症中的诊断作用。方法 对３９例 有Ｌ５和Ｓ１神经损害表现的腰椎间航空出症的患者进行胫后神经体感诱发电位（ＳＥＰ）和Ｌ５Ｓ１ＤＳＥＰ检查,测定其Ｎ４０的峰潜伏期。结果 胫后神经ＳＥＰ检测的异常率为３８．５％,其中多 水平突出的异常率明显高于单水平突出的异常率（Ｐ＝－．００８）;而Ｌ５Ｓ１ＤＳＥＰ检测的异常率达８５．７％,比胫后神经ＳＥＰ检测的异常率