腰椎间盘突出症临床诊断探讨—附44例手术病例分析

分析了44例诊断为腰椎间盘突出症并经手术治疗的病例资料,探讨了腰椎间盘突出症、腰椎间盘突出症合并腰椎管狭窄、腰椎管狭窄症三种疾病的特点,发现它们均造成椎管容积减小和神经根受压这一基本病理改变,临床表现相近,因此,诊治腰椎间盘突出症时要注意大多伴有腰椎管或神经根管的狭窄。

A SURVEY OF CLINICAL DIAGNOSIS OF LUMBAR INTERVERTEBRAL DISC PROTRUSIONS

Clinical diagnosis of lumbar intervertebral disc protrusions have been operated in 44 patients.After operation,the diagnosis were comfirmed 30 disc herniations,in which i6 accompanied with spinal stenosis,13 lumbar spinal canal stenosis and 1 adhesive arachnoiditis.Only 70% of the diagnosis coodinated.In order to find out a diagnostic clue to distinguish these lesions,43 cases of PNP and stenosis were divided into three groups to compare their history,onset of disease,symptoms and signs.There was no significant difference between these three groups.Two points must be. emphysized(1)Intermittent claudication,which is known as specific picture of spinal stenosis,was noted in 7 PNP patients;and signs of root irritation are characterestic of PNP,were also found in spinal stenosis.So when a patient has intermittent claudication may be due to a lumbar disc protrusion, while sciatica with radicalar signs are also suggestive of lumbar spinal stenosis.Besides,it is difficult to make a distinction between disc protrusion and lateral recess stenosis before operation by clinical pictures.(2) Progressive degeneration of the lumbar vertebrae is the pathologic bases of both disc herniation and spinal stenosis.Up to the present,it's impossible to know which comes first,however these lesions usually presented at the same time.When performing operation,ore must bear in mind the degenerative factors,it is necessary not only to excise the protruded disc but also to explore the spinal canal and decompress the entrapped roots completely at the same time.