特殊类型腰椎间盘突出症延迟诊断26例原因分析和临床对策

目的 探讨特殊类型腰椎间盘突出症延迟诊断的原因和对策。方法 1988年1月—2002年12月手术治疗腰椎间盘突出症489例中发生延迟诊断的26例进行分析。结果 发生延迟诊断原因有(1)诊治医生经验不足，过分依赖CT检查而忽视临床表现。(2)对游离型，极外侧型和高位椎间盘突出症缺乏系统认识。(3)常规CT检查只作椎间隙平扫易遗漏病变。(4)病情复杂，情况特殊导致诊断困难。结论 (1)腰椎间盘突出症的诊断主要应根据临床症状，体征，不能完全依赖CT影像。(2)特殊病例增加椎体CT扫描或MRI检查有利于发现病变。(3)提高经验，增强对特殊类型腰椎间盘突出症系统的认识，提高阅片基本功能有效减少工作中的失误。

The analysis and counter strategy to the special protrusion of the lumbar intervertebral disc

Objective This paper deals with the cause and the counter strategy of the special sorts of lumbar intervertebral disc protrusion diagnosed delayedly.Methods By the analysis to the 26 cases among the 489 ones operated from Jan. 1988 to Dec. 2002.Results The results to lead to the delayed diagnosis due to:(1)The orthopedists had inadequate experience and to rely on too much the CT examination so that ignore the patients' clinical case.(2)lack of recognition to the symptoms of dissociated,extra-lateral or high level protrusion of the intervertebral disc.(3)Easily omit the pathological changes only by the flat scanning of the lumbar vertebra.(4)Sometimes the most complex illness may mislead the orthopaedists.Conclusion (1)The doctar is when diagnosing,he should pay more attention to the clinical symptoms and does not lie too much on the CT.(2)Use added CT scanning or MRI examination on the vertebra to find the omitted pathological changes.(3)To derote to much more expesicemes about the system of the protrusion of the intervertebral disc prutrusionby developing the skills of study X-ray film to avoid the fault.