腰椎管侧隐窝狭窄症的再认识  

Lumbar Lateral Recess Stenosis and Several Factors in Diagnosis of Lateral Recess Syndrome

作　　者：侯树勋[1] 吴闻文[1] 商卫林[1] 欧阳忠南[1] 韦兴[1] 

机构地区：[1]解放军304医院骨科

出　　处：《中华骨科杂志》1997年第12期734-736,I002,共4页Chinese Journal of Orthopaedics

摘　　要：作者对１５３例因下腰痛手术治疗在术前进行过ＣＴＭ检查的患者作了影像学及临床分析。按形态不同，侧隐窝可分为五种类型：（１）三角型：即整个椎管呈倒三角形，其侧隐窝完全开放；（２）猫耳型：因后关节和椎体后缘轻度增生，形成底宽顶尖的侧隐窝，整个椎管如同猫头，侧隐窝为猫耳，基本开放；（３）牛角型：因关节突向椎体方向过度增生使侧隐窝呈横向伸开的带状，中央椎管不窄，横断面形如牛头，侧隐窝为牛角，严重者侧隐窝可近于闭塞；（４）三叶草型：双侧后关节及椎板内聚并伴有关节突极度增生再加上向后正中突入的椎体后缘，使整个椎管呈三叶草状，侧隐窝和中央椎管均狭窄；（５）混合型：多为上述形状的混合或两侧侧隐窝发育不对称。前二型不易形成对神经根的压迫，后三型易造成压迫。但即使最狭窄的侧隐窝也不一定产生症状，因为关键在于神经根和侧隐窝的相对关系。因此作者提出单纯依靠测定侧隐窝的宽度不能诊断侧隐窝狭窄症，而是要判断神经根是否被侧隐窝压迫。本文描述的神经根逃逸＂现象是无症状型侧隐窝狭窄的主要病理基础。The authors analysed the results of preoperative CTM and clinical data in 120 patients undergoing decompressive surgery for low back pain. Morphologically, their lateral recesses were classified as following five types: type Ⅰ: “triangle ',i.e.,the whole spinal canal shown as a reversed triangle shape with totally opened lateral recesses; typeⅡ: “cat ear', i.e.,the canal shown as a cat head and the partially opened lateral recess as its two ears; type Ⅲ: “ox horn', the posteriorly protrused hypertrophic facets leading to a narrowing lateral recess without central canal stenosis, consequently the central canal shown as a head and the lateral recesses as two horns; type Ⅳ: “trilobed', the severe hypertrophy of facets and posterior margin of vertebral body causing both the central canal and lateral recess stenosis, shown as trilobed; type Ⅴ: “mixed type', the combination of the types described above or congenital asymmetry of lateral recesses. For typeⅠandⅡ, the possibility of the nerve root compression is low, and for type Ⅲ,Ⅳ andⅤ, the possibility may be much higher. However, it should be emphasized that the narrowest lateral recess would not necessarily cause any clinical symptom which only depended upon the anatomic relation between the lateral recess and the nerve root. Therefore, the authors suggest that the diagnosis of lateral recess syndrome should be based on the evidence of the compression of nerve root, rather than the saggital distance of bony lateral recess.The“nerve root escape”phenomenon described in the paper is the major pathological basis of asymptomatic lateral recess stenosis.

关 键 词：侧隐窝狭窄症 下腰痛 CTM 诊断 腰椎管狭窄 

分 类 号：R681.504[医药卫生—骨科学]