游离型腰椎间盘突出症的诊治

目的 探讨游离型腰椎间盘突出症的病理特点及其在诊断、治疗等方面的特殊性。方法 分析49例游离型腰椎间盘突出症的临床资料。结果 游离型腰椎间盘突出症起病急，症状重，CT及MRI分辨率虽高，但易出现假阴性。腰椎管造影在一定程度上可弥补其不足；由于游离在椎管间盘组织的压迫，神经根多处于固定状态，术中移动神经根及摘除髓组织时易损伤神经根及硬膜囊。结论 游离型腰椎间盘突出症一旦确诊应早期手术；术前应详读X线CT、MRI等资料，有疑问时应行椎管造影；在取出游离于椎管内的间盘组织时，残余碎块未取净是腰椎再次手术的常见原因之一。

Diagnosis and therapy of the free protrusion of the lumbar intervertebral disc

Objective To study pathologic feature of free protrusion of the lumbar intervertebral disc and special features in diagnosis and therapy.Methods Clinical data of 49 case with free type lumbar disc herniation were analyzed.Results The sudden onset and severe symptom were important specialities in free protrusion of the lumbar intervertebral disc,CT and MRI could give false negtive result,while myelography could complement deficiency in some degree;Nerve root was usually oppressed by the free protruded tissue and become located.The nerve root and dura mater of spinal cord could be hurt when operated to move the nerve root or took the nucleus pulposus tissue.Conclusion Early operation should be performed once free protrusion of the lumbar intervertebral disc;X ray films,CT,MRI should be reviewed carefully before operation,myelography should be done if question exist.When remove the free protruded fregments,the residue often is the case of reoperation of lumbar vertebrae.