腰椎5神经根不同部位受压患者临床特征分析  

Clinical Characteristics of Patients With Different L_5 Nerve Root Compression Sites

作　　者：成赋斌[1] 杨先文[2] 

机构地区：[1]武警广东省总队医院军人病区,广东省广州市510507 [2]武警广东省总队医院综合科,广东省广州市510507

出　　处：《中国全科医学》2016年第8期976-978,共3页Chinese General Practice

摘　　要：背景腰椎管内狭窄的主要症状是下肢痛且行走时加重,并伴有间歇性跛行,而静息性下肢痛则被认为是腰椎间盘突出压迫神经根引起神经症状时的重要表现。国内静息性下肢痛与症状性椎间孔狭窄的关系报道较少。目的探讨腰椎5(L_5)神经根不同部位受压患者的临床特征,为精确和细化临床诊断、治疗提供依据。方法选取2013年8月—2015年6月于武警广东省总队医院就诊的主诉为单侧下肢痛的患者173例为研究对象,根据L_5神经根受压部位,将患者分为L_4/L_5椎管内狭窄组(A组,n=95)和L_5/S_1椎间孔狭窄组(B组,n=78)。记录术前腰椎日本骨科协会(JOA)评分,采用视觉模拟评分(VAS)评价术前静息性下肢痛、行走时下肢痛及腰痛程度,检查胫骨前肌和拇长伸肌肌力、直腿抬高试验及Kemp's征。结果 B组静息性下肢痛发生率高于A组,差异有统计学意义(P<0.05)。两组行走时下肢痛VAS、腰痛VAS及间歇性跛行、胫骨前肌或拇长伸肌肌力下降发生率、直腿抬高试验阳性率、Kemp's征阳性率比较,差异均无统计学意义(P>0.05)。B组静息性下肢痛患者疼痛VAS为6.0(6.0)分,高于A组静息性下肢痛患者的2.0(4.0)分,差异有统计学意义(Z=4.00,P<0.001)。结论静息性下肢痛可能是L_5/S_1椎间孔狭窄刺激L5的显著临床特征,静息性下肢痛的患者应重视L_5/S_1椎间孔狭窄引起的L_5神经根受累。Background Lumbar intra- spinal canal stenosis is characterized by leg pain that intensifies during walking and intermittent claudication,while leg pain at rest is a characteristic neurological symptom of lumbar disc herniation compressing nerve root.So far,there is a lack of research about the association between leg pain at rest and symptomatic foraminal stenosis.Objective To investigate the clinical features of patients with different L_5 nerve root compression sites,in order to provide references for precise clinical diagnosis and treatment.Methods We enrolled 173 patients with unilateral leg pain who received treatment from August 2013 to June 2015 in Armed Police Corps Hospital of Guangdong Province.According to L_5 nerve root compression site,the patients were divided into the L_4/L_5 spinal canal stenosis group（group A,n = 95） and L_5/S_1 lumbar foraminal stenosis group（group B,n = 78）.Japanese Orthopaedic Association（JOA） score of lumbar vertebra was recorded;visual analogue scale（VAS） scores of leg pain at rest,leg pain when walking and lumbago degree before surgery were evaluated;tibialis anterior muscle,muscle strength of extensor pollicis longus,straight leg raising test and Kemp＇s sign were examined.Results Group B was higher than group A in the incidence of leg pain at rest（P〈0.05）.The two groups were not significantly different in VAS of leg pain when walking,VAS of lumbago and incidence rates of intermittent claudication and the decrease of muscle strength of tibialis anterior muscle or extensor pollicis longus,the positive rate of straight leg raising test and the positive rate of Kemp＇s sign（P〉0.05）.The VAS of leg pain at rest of group B was higher than that of group A（6.0（6.0）vs 2.0（4.0）,Z =4.00,P〈 0.001）.Conclusion Leg pain at rest may be an outstanding clinical feature of L_5/S_1intervertebral foramen stenosis.Patients with leg pain at rest should attach importance on the L_5 nerve root involvement induced by L_5/S_1 foraminal stenosis.

关 键 词：神经根压迫 腰椎 椎管狭窄 椎间孔狭窄 

分 类 号：R745.43[医药卫生—神经病学与精神病学]