非典型游离腰椎间盘脱出伴马尾综合征的诊断及手术时机  

Diagnosis and operation timing for atypical sequestered lumbar disc herniation combined with cauda equina syndrome

作　　者：高升[1] 王霞[2] 耿晓鹏[1] 李建军[1] 付国勇[1] 牛冲[1] 房清敏[1] 孙兆忠[1] 

机构地区：[1]滨州医学院附属医院,山东滨州256603 [2]滨州市人民医院,山东滨州256610

出　　处：《中国矫形外科杂志》2017年第17期1546-1551,共6页Orthopedic Journal of China

基　　金：山东省医药卫生科技发展计划项目(编号:2013WS0300)

摘　　要：[目的]熟悉非典型游离腰椎间盘突出(SLDH)伴马尾综合征(CES)的特殊影像学表现,减少此类特殊急症患者的误诊并探讨其手术时机。[方法]回顾性分析本科2012年8月~2015年6月行手术治疗的非典型SLDH伴CES患者42例。对此类特殊急症患者的影像学资料进行归纳分析与总结。根据发病至手术的时间间隔将其分为三组,其中,24 h内手术的15例(24 h内组);24~48 h内手术的11例(24~48 h组);超过48h的16例(超过48 h组)。采用Oswestry功能障碍指数(ODI)及Gleave泌尿系统恢复标准评估手术疗效,统计并比较三组患者的并发症发生率。[结果]所有患者均得到完整随访,随访时间14~19个月,平均17.6个月。42例患者术前MRI上游离髓核表现为T1像的低信号,T2像的稍高信号(31例)或低信号(11例)。强化MRI中病程在2周以上的12例(29%)患者呈现周边环形强化影。术后3、6个月及末次随访时24 h内组较24~48 h组患者ODI评分差异有统计学意义(P<0.05),24~48 h组与超过48 h组差异无统计学意义(P>0.05)。依据末次随访疗效,按照Gleave泌尿系统恢复标准,24 h内组患者优良率为93.33%;24~48 h组优良率54.55%;超过48 h组50.00%。24 h内组较24~48 h组差异有统计学意义(P<0.05),24~48 h组与超过48 h组比较差异无统计学意义(P>0.05)。随访期间24 h组患者未出现并发症;24~48 h组并发症发生率为9.09%;超过48 h组18.75%。[结论]非典型SLDH伴CES患者有其特殊影像学征象,术前必须对其充分熟悉并结合临床资料进行综合性诊断评估。此类特殊急症患者CES的最佳手术时间窗为24 h内,早期手术减压也可减少并发症的发生。[Objective] To acknowledge the imaging characteristics of atypical sequestered lumbar disc herniation （SLDH） accompanied by cauda equina syndrome （CES） , for reducing the misdiagnosis of this specific emergency and ex- ploring the timing of surgery. [Methods] Between August 2012 and June 2015, 42 patients with SLDH accompanied with CES received surgical treatment in our department. The imaging data of these patients were reviewed and analyzed. According to the time interval from onset to surgical treatment, 15 patients were surgically treated within 24 hours （Group A） , while 11 patients underwent operation from 24 to 48 hours （Group B） , and 16 cases received surgery more than 48 hours （Group C） . Oswestry disability index （ODI） and Gleave urinary system recovery criteria were used for evaluation of outcomes during tile follow-up period. Additionally, complications were statistically compared among the tilree groups. [ Results ] Before opera- lion, the sequestered disc tissues presented a low signal in T 1 weighted MRI in all of the 42 patients, whereas a slightly high sig- nal in 31 patients and a low signal in 11 cases in T2 weighted imaging. Additionally, phenomenon of annular enhancement was noted with gadolinium enhanced scan in 12 patients who had the lesion more than 2 weeks. Decompression and removal of sequestered disc were successfully condueted in all patients. No complication, such as cerebrospinal fluid leakage and re- currence of disc prolapse, was noted in any patient of Group A, however, the complication rate reached 9.1% and 18.8% in Group B and C respectively. All patients were followed up for 14-19 months with a mean of 17.6 months. At 3 months, 6 months and the last follow-up, ODI scores in Group A proved significantly lower than that in Group B and C （P〈0.05） . Al- though ODI in Group B were also lower than Group C, no statistical difference was found between them （P〉0.05） . According to Gleave criteria, urinary function was graded as excellent and good in

关 键 词：非典型游离腰椎间盘突出 马尾综合征 误诊 手术时机 

分 类 号：R687.3[医药卫生—骨科学]