梗阻型腰椎间盘突出症(附21例图像分析报告)

报告21例梗阻型腰椎间盘突出症的临床特点与图像分析的结果。21例中男16例,女5例,平均41岁;病程1.5～6个月,21例均有腰痛及单/双侧坐骨神经痛,同时有肛门、会阴部麻木和痛觉减退。另选10例旁中央型椎间盘突出症经手术证实者作对照,这10例仅有腰痛及坐骨神经痛,而无鞍区的症状和体征。31例均行手术治疗。图像分析方法:将CT断层扫描图像在MAS-1图像分析系统上作图像分析,在486计算机上分别计算出同一层面椎管和突出物的面积,再算出突出物所占同一层面椎管面积的百分率;结果显示31例疗效均满意。21例梗阻型平均随访1.5年,根性症状完全消失,肛门、会阴部症状3/4消失,1/4明显缓解,图像分析结果:21例有马尾神经受损表现者,其突出物占同一椎管截面积60.4％～75.8％,平均66.7％。对照组10例貌似大块旁中央型突出,所占面积为39.5％～54.7％,平均47.3％。认为突出物占椎管同一截面积60％以上才会出现马尾受损害的症状。

Obstructive Lumbar Disc Herniation

The clinical characteristic and imaging analysis result of twenty one cases with lumbar disc herniation were re-ported.Twenty one cases were conducted including 16 male and 5 female, with average age of 41 years old, and the course of diseases from 1.5 to 6 months. All cases were complained of low back pain, single/double sciatic nerve pain, presenting paralysis and pain-decreasing in anus and perineum.The other 10 central lumbar disc herniation cases were chosen as control group with low back pain and sciatic nerve pain but cauda equina symptom. All 31 cases were treated by operation. Method of imaging analysis: the CT foraminal and ruptured areas were measured by MAS - 1 computerized imaging analysis system, then the rates of foraminal and ruptured area were calculated. Results showed that the nerve root pain disappeared in 21 obstructive disc cases besides the symptom of anus perineum disappeared in 3/4 and alleviated in 1/ 4 cases within 1.5 years follow-up. Imaging analysis showed that the rate of foraminal and ruptured area was 60.4% ~ 75.8% (average 66.7%) in 21 obstructive cases and 39.5% ~ 54.7% (average 47.3%) in 10 control group cas-es. Authors consider that the cases with the area rate above 60% of foraminal and ruptured area might present cauda e-quina symptom.