创伤性腰骶丛神经根损伤的临床分型

  目的 探讨腰骶丛神经根性损伤的临床分型。 方法2004 年11 月至2011 年8 月, 共为 36 例创伤性腰骶丛神经根损伤患者进行腹膜后腰神经丛及(或)盆腔内骶神经丛及(或)腰骶管神经根 手术探查。男24 例, 女12 例;年龄7~49 岁, 平均29.5 岁。伤后时间为2~36 个月, 平均9.3 个月。对每 例患者术中探查的神经根损伤情况与其术前临床表现、物理查体一并进行分析、归纳, 总结出不同组合 的腰骶丛神经根联合损伤的临床表现特点并进行临床分型。 结果 将腰骶丛神经根损伤分为六型:腰 骶丛神经根完全损伤型(L1~S3)4 例, 腰丛+上骶丛损伤型(L1~S1)6 例, 骶丛神经损伤型(L4~S3)9 例, 上骶 丛损伤型(L4~S1)11 例, 下骶丛损伤型(S2, 3)4例, 腰丛神经损伤型(L1~4)2 例。全腰骶丛神经根损伤型、腰 丛+上骶丛损伤型及骶丛神经根损伤型者共19 例, 73.7%(14/19)的损伤部位位于椎管内, 且均发生神经 根的断裂或撕脱。而上骶丛、下骶丛及腰丛神经根损伤共17 例, 其中64.7%(11/17)的损伤部位在盆内 段及(或)骶前孔处, 均为挫伤或牵拉伤。 结论 上述临床分型基本涵盖腰骶丛神经根损伤的常见类型, 为腰骶丛神经根损伤范围的判定提供科学依据。此外, 不同类型的腰骶丛神经根损伤, 其损伤部位及性 质明显不同, 对预后的判定及治疗方案的选择具有重要意义。

Clinical typing of lumbosacral plexus nerve root injury caused by trauma

Objective To classify the type of lumbosacral plexus nerve root injury. Methods From November 2004 to August 2011, 36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department. There were 24 males and 12 females, aged from 7 to 49 years(average, 29.5 years). By inductively analyzing the location and amount of nerve root injury, preoperative clinical manifestations and Results of physical examination, the clinical typing of lumbarsacral plexus nerve root injury was made. Results Lumbosacral plexus nerve root injury was classified into 6 types: total lumbosacral plexus nerve root injury (4 cases), lumbar plexus and upper sacral plexus nerve root injury (6 cases), sacral plexus nerve root injury (9 cases), upper sacral plexus nerve root injury (11 cases), lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases). There were 19 patients with total lumbosacral plexus nerve root injury, lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury, among which 73.7%(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture. There were 17 patients with upper sacral plexus nerve root injury, lower sacral plexus nerve root injury or lumbar plexus nerve root injury, among which 64.7% (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina, and all of them were distraction injury. Conclusion This clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury. In addition, it is also beneficial for judging the location and characteristics of nerve root injury.