极外侧型腰椎间盘突出症的诊治特点

目的：探讨极外侧型腰椎间盘突出症的诊治特点。方法：回顾性分析16例病人的症状,体征,影像学表现和手术。结果：坐骨神经痛11例,腰痛3例,股神经牵拉试验阳性9例,直腿抬高试验阳性4例,椎间盘突出L4／5间隙9例,结论：极外侧型腰椎间盘突出症腿痛多较腰痛严重,直腿抬高试验阳性率低,好发于L4／5且压迫同节段的神经根,影像学表现是主要诊断依据。手术入路依突出位置和病理类型而定。     

腰椎间盘突出部位与直腿抬高试验(根性征)关系的研究

目的对直腿抬高试验与腰椎间盘突出部位的关系进行了相关探索,讨论腰腿痛的致病机制,为临床诊断和选择治疗方法提供指导。方法收集102例腰椎间盘突出症的临床资料,根据MRI与神经根关系分为4组,用医学统计软件SPSS13.0进行统计学处理。结果患者腰椎间盘突出症MRI分型和临床分型具有相关性。①直腿抬高试验是否阳性与性别、年龄、病程无关;②患肢出现直腿抬高试验阳性率与椎间盘突出方向密切相关;③直腿抬高试验的出现与疼痛的致病机制密切相关。结论通过本组分析应重新认识直腿抬高试验的临床意义。     

直腿抬高试验阴性的腰椎间盘突出症：附55例临床分析

直腿抬高试验阴性的腰椎间盘突出症（附５５例临床分析）朱爱军，郑国明，姚舜华，谢跃，戴志唐腰椎间盘突出症是骨科临床的常见病、多发病，而直腿抬高试验阳性是诊断本病的重要体征。被手术证实的腰椎间盘突出症出现直腿抬高试验阴性者并不多见。有学者综合各家报告其发...     

椎间隙突出髓核内压力与相邻神经根受压程度的临床研究

目的：观察腰椎间盘突出症患者突出髓核内压力与神经根受压程度的关系。探讨突出髓核组织的临床意义及手法治疗的机制。方法：选取腰椎间盘突出症手术患者30例，根据直腿抬高试验分为直腿抬高阳性组、阴性组，术中测量患者突出髓核内压力大小、观察突出髓核内压力与直腿抬高高度的关系；同时选取收治的手法治疗腰椎间盘突出症患者30例，观察手法治疗后直腿抬高高度的变化。结果：①手术患者中直腿抬高阳性组患者突出髓核内压力明显高于阴性组患者，具有显著意义(P＜0．01)。两组患者突出髓核大小无明显差异(P＞0．05)。②手法治疗患者中手法治疗后直腿抬高高度明显增加(P＜0．01)，手法治疗前后CT或MRI显示突出髓核大小无改变(P＞0．05)。结论：①突出髓核对神经根的压迫与突出髓核内压力有关，突出髓核内压力较大时患者直腿抬高受限，突出髓核内压力较小时直腿抬高不受限。突出髓核对神经根的压迫与突出髓核大小尚未见明显关系。②推测手法治疗可以通过降低突出髓核内压力减轻甚至解除神经根受压，可能不是仅依靠改变突出髓核空间占位达到治疗目的。     

对老年性腰椎间盘突出症理学诊断的探讨

目的：探讨老年性常见病腰椎间盘突出症的理学诊断价值。方法：对64例老年性腰椎间盘突出症患者的病史、临床表现、体征及术中所见进行分析，从直腿抬高试验(straight：legraisingtest，SLRT)阳性、间歇性跛行(intermittent claudication，IC)阳性及直腿抬高试验和间歇性跛行同时阳性三个方面进行比较分析。结果：单纯直腿抬高试验阳性率为14．06％，直腿抬高试验总阳性率67．19％；单纯间歇性跛行阳性率32．82％，总阳性率85．92％；间歇性跛行和直腿抬高试验同时阳性率53．12％，间歇性跛行和直腿抬高试验总阳性率100％。结论：老年性腰椎间盘突出症合并腰椎管狭窄和腰椎间盘突出同时存在，因此间歇性跛行和直腿抬高试验是老年性腰椎间盘突出症有效的诊断方法。     

对老年性腰椎间盘突出症理学诊断的探讨

目的:探讨老年性常见病腰椎间盘突出症的理学诊断价值。方法:对64例老年性腰椎间盘突出症患者的病史、临床表现、体征及术中所见进行分析,从直腿抬高试验(straight leg raising test,SLRT)阳性、间歇性跛行(intermittent claudication,IC)阳性及直腿抬高试验和间歇性跛行同时阳性三个方面进行比较分析。结果:单纯直腿抬高试验阳性率为14.06％,直腿抬高试验总阳性率67.19％;单纯间歇性跛行阳性率32.82％,总阳性率85.92％;间歇性跛行和直腿抬高试验同时阳性率53.12％,间歇性跛行和直腿抬高试验总阳性率100％。结论:老年性腰椎间盘突出症合并腰椎管狭窄和腰椎间盘突出同时存在,因此间歇性跛行和直腿抬高试验是老年性腰椎间盘突出症有效的诊断方法。     

对老年性腰椎间盘突出症理学诊断的探讨

目的:探讨老年性常见病腰椎间盘突出症的理学诊断价值.方法:对64例老年性腰椎间盘突出症患者的病史、临床表现、体征及术中所见进行分析,从直腿抬高试验(straight leg raising test,SLRT)阳性、间歇性跛行(intermittent claudication,IC)阳性及直腿抬高试验和间歇性跛行同时阳性三个方面进行比较分析.结果:单纯直腿抬高试验阳性率为14.06%,直腿抬高试验总阳性率67.19%;单纯间歇性跛行阳性率32.82%,总阳性率85.92%;间歇性跛行和直腿抬高试验同时阳性率53.12%,间歇性跛行和直腿抬高试验总阳性率100%.结论:老年性腰椎间盘突出症合并腰椎管狭窄和腰椎间盘突出同时存在,因此间歇性跛行和直腿抬高试验是老年性腰椎间盘突出症有效的诊断方法.     

腰神经根管狭窄症的临床特征

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（＋）变腰位（－）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。（3）扩大开窗根管减压是该病有效的术式。     

膝屈曲试验检查腰椎间盘突出症

直腿抬高试验 ,股神经牵拉试验是检查腰椎间盘突出症最常见的项目。本文介绍一种新试验 ,即膝屈曲试验 (KneeFlexion Test,KFT) ,能提示腰骶神经根的紧张性 ,从而预示腰椎间盘突出症。一、资料与方法回顾 5年中 36 2例有腰腿痛的病例 ,均进行直腿抬高试验、股神经牵拉试验和膝屈曲试验。膝屈曲试验的方法是患者俯卧位 ,屈曲膝关节 ,如在同侧臀部并 (或 )大腿后侧产生疼痛或疼痛加重时 ,则试验阳性。结果分为阴性 ,轻度、中度和显著阳性。全部患者均进行 L4～ 5,L5～ S1的 CT,脊髓造影术或 MRI检查 ,最后诊断腰椎间盘突出症 2 84例 ,其…     

腰4.5神经根交通支的基础研究

对２６具成人尸体上的腰４．５神经根及其交通支进行了观察。认为腰４．５神经根的交通支是股神经牵拉试验时出现同侧坐骨神经痛及直腿抬高试验时同侧股神经刺激征的解剖学基础。以上体征为腰４．５椎间盘突出症所特有。     

脊柱内窥镜技术治疗腰椎间盘突出症79例分析

目的：探讨脊柱内窥镜下经椎间孔进入椎管行髓核摘除、神经根松解术治疗腰椎间盘突出症的安全性及有效性。方法79例腰椎间盘突出症患者,经椎间孔逐级磨钻扩张至一区,安放工作套管,在脊柱内窥镜下完成髓核摘除、神经根松解术。采用视觉模拟评分法（VAS）评定,临床疗效用改良的MacNab评价方法评定疗效。结果治疗后1~5天,直腿抬高试验及加强试验与治疗前对比有显著性改善（P﹤0.01）;治疗前后1、3、6个月各时段VAS评分,经比较有显著性改善（P﹤0.01）;治疗后1、3、6个月各时段的临床疗效,显效率1个月94.94%、3个月96.20%、6个月96.20%,显示治疗后总有效率98.73%,有明显的统计学意义（P〈0.05）。结论脊柱内窥镜技术是一种安全、有效、并发症少、适应症广、复发率低的微创治疗腰椎间盘突出症的新方法。     

Significance of the straight-leg-raising test in the diagnosis and clinical evaluation of lower lumbar intervertebral-disc protrusion

The cases of 113 patients who had protrusion of a lumbar intervertebral disc were analyzed to determine the relationship between the findings at operation and the location of the pain that resulted from the straight-leg-raising test. The study showed a close relationship between the location of the pain and the position of the protrusion of the disc. The degree of limitation of straight-leg raising was also found to have a direct relationship to the size and position of the protrusion and to its relationship to the spinal nerve. The protrusions were classified into three types according to position in relation to the dura mater and to the pattern of pain that was induced by passive straight-leg raising. On straight-leg raising, central protrusions tended to cause pain in the back, lateral protrusions caused pain in the lower extremity, and intermediate protrusions caused both. On this basis, the distribution of pain on straight-leg raising allowed an accurate prediction of the location of the lesion in 100 (88.5 per cent) of the 113 patients.     

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。     

特殊类型椎间盘突出症临床特点与疗效分析

目的　探索胸椎间盘突出、腰椎极外侧椎间盘突出及硬脊膜内椎间盘突出的临床与外科处理特点。方法　自 1985～1998年以来 ,共收治 15例胸椎间盘突出 ,12例腰椎极外侧椎间盘突出 ,5例腰椎硬脊膜内椎间盘突出共计 32例。对其临床特点、影像征象 ,手术疗效进行了分析。结果　胸椎椎间盘突出 ,具有明显的椎体束征与肋间神经受压症状 ;腰椎极外侧椎间盘突出 ,以坐骨神经放射痛为主 ,腰痛轻微、抬腿试验可以阴性 ,可有上位或下位神经根受压定位体征 ;硬膜内椎间盘突出 ,表现强迫体位 ,呈现大小便异常。结论　分析特殊类型椎间盘突出的特点 ,为其诊断、手术入路的选择提供有益经验     

椎间孔镜治疗有典型根性症状的腰椎手术失败综合征

目的：评价椎间孔镜治疗有典型根性症状的腰椎手术失败综合征（failedbacksurgerysyndrome,FBSS）的临床效果。方法选择2012年11月～2013年6月12例有典型根性症状的FBSS,其中腰椎间盘突出单纯开窗髓核摘除术后复发5例,腰椎管狭窄髓核摘除并神经根管减压术后复发3例,腰椎间盘突出椎间孔镜髓核摘除术后复发4例。均采用椎间孔镜治疗。结果12例术后患肢直腿抬高试验阴性,神经根刺激所致的患肢疼痛症状均明显缓解,患肢疼痛评分依据视觉模拟评分法（visualanaloguescore,VAS）,术前8．3±1．9,术后1个月2．6±1．1（t＝16．301,P＝0．000）。结论椎间孔镜是治疗有典型根性症状的FBSS安全和有效的微创手术,合理选择手术适应证和成熟的椎间孔镜手术经验是保证手术成功的关键。     

小切口加脊柱花刀治疗髓核骨化性腰椎间盘突出症

为保留腰椎后部结构的完整性，防止术后腰椎不稳，采用小切口单侧小开窗加脊柱花刀治疗旁侧型髓核骨化性腰椎间盘突出症22例，单侧扩大开窗加脊柱花刀治疗中央型髓核骨化性腰椎间盘突出症10例。手术尽可能地保留了腰椎全部结构的完整性，可防止术后腰椎不稳和减少对硬膜和神经根的疤痕粘连。并就32例髓核骨化性腰椎间盘突出症患者CT图像中髓核骨化的形式和形态进行了讨论。     

Presence and intensity of the Lasegue sign in relation to the site of lumbar intervertebral disc herniation]

The manouevre of stretching the sciatic nerve known as the Lasegue test is very useful in the clinical evaluation of patients with suspicion of lumbar disc herniation and has been in use for over 100 years. The relationship between the intensity of the Lasegue test and intraoperative localization of disc herniation is presented. The material comprised 87 cases (54 males and 33 females) aged 47 (+/- 9) years. Duration of symptoms was on average 9 months (+/- 7.5 months). The Lasegue sign was positive in 84 patients and negative in 3 patients (absent in 1 case, and more than 70 degrees in 2 cases). In the investigated group the Lasegue sign was positive at 39 degrees (+/- 22 degrees) on average. The obtained results indicate a strong relation between a positive Lasegue sign and disc herniation leading to direct spinal nerve or nerve sheath compression.     

腰椎间盘突出症术后再手术原因分析与对策

目的分析腰椎间盘突出症术后再手术原因并探讨诊疗策略。方法回顾分析39例腰椎间盘突出症再手术患者的病史、体格检查、影像学表现、初次手术方案、再次手术探查结果及相应的再次手术方案。结果腰椎间盘突出症术后再手术的主要原因有：①椎间盘突出。②腰椎不稳。③椎管狭窄。④椎管内瘢痕形成。⑤漏诊和（或）误诊。39例均获随访,时间3-36个月,腰椎术后临床疗效评定参考侯树勋等制定的评价标准：优23例,良8例,可5例,差1例。颈椎手术1例术后JOA评分17分,疗效为优;胸椎手术1例,参考脊柱手术后Beau jon-Lassale功能评分标准评分：20分,疗效为优。结论腰椎间盘突出症初次术后,腰腿痛复发或症状无缓解甚至加重,原因大部分为医源性。应严格把握手术指征,针对不同病因对患者制定个性化再手术方案。     

A study of the relationship between type of lumbar disc herniation,straight leg raising test and peripheral T lymphocytes

Objective: To observe changes in peripheral T lymphocytes of patients with lumbar disc herniation, and investigate the relationship between the type of herniation, signs and T lymphocyte subsets. Methods: Blood samples from 20 healthy blood donors (control group), and 49 patients (27 male and 22 female) with single‐level lumbar intervertebral disc herniation were collected, the latter preoperatively. T lymphocytes subsets were detected by flow cytometer. According to the position of the intervertebral disc observed during surgery, the patients were divided into ruptured disc herniation (RDH) and degenerative disc herniation (DDH) groups. Straight leg raising (SLR) was assessed preoperatively. Results: Percentages of CD3+, CD4+, and ratio of CD4+/CD8+ in the RDH group were significantly higher, and of percentage of CD8+ significantly lower, than were those in the control group. Percentages of CD4+ and ratio of CD4+/CD8+ were significantly higher, and percentage of CD8+ significantly lower, in the positive SLR test group than were those in the negative SLR test group. The positive rate of SLR testing was significantly higher in the RDH than in the DDH group. Conclusion: Our results suggest that changes in T lymphocyte subsets in peripheral blood take place after herniation of the lumbar intervertebral disc. T lymphocyte mediated immune responses may play an important role in the occurrence and development of signs in patients with herniated lumbar intervertebral discs. The SLR test may help to confirm that disc herniation has caused nerve root impairment by mechanical loading or inflammatory stimulus and provide guidance on the choice of treatment.     

Nerve root pressure in lumbar disc herniation.

STUDY DESIGN: The contact pressure between the nerve root and lumbar disc herniation was measured and compared with clinical features. OBJECTIVE: To assess levels of actual compression to the nerve root in clinical cases. SUMMARY OF BACKGROUND DATA: Actual levels of pressure to the nerve root of lumbar disc herniation in clinical cases is unknown. METHODS: The study was performed on 34 patients who had lumbar disc herniation. All of them had been treated by open discectomy. After laminotomy, nerve root pressure was measured by inserting a transducer between the nerve root and the disc herniation. The magnitude of pressure was compared with clinical features. RESULTS: Nerve root pressures before discectomy were varied from 7 mm Hg to 256 mm Hg (mean, 53 mm Hg). After discectomy, the contact pressure was 0 mm Hg in all cases. There were no significant correlations between the magnitude of nerve root pressure and limits to the degree of straight leg raising, duration of symptoms, and age of the patients. However, the magnitude of the pressure in patients with neurologic deficits and trunk list was significantly higher than in the absence of these findings. CONCLUSIONS: The contact pressure exerted by lumbar disc herniation on the nerve roots was recorded during surgical intervention, and the mean pressure was 53 mm Hg. The magnitude of nerve root pressure was not correlated with the degree of straight leg raising, but with the severity of neurologic deficits.