硬膜外静脉丛曲张致腰腿痛研究进展  

Varicose epidural plexus, a neglected cause of low back pain

作　　者：赵娜[1] 倪维宇 梁奕 胡子昂[1] Zhao Na;Ni Weiyu;Liang Yi;Hu Ziang(Department of Orthopaedic Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,浙江省骨骼肌肉退变与再生修复转化研究重点实验室,杭州310016

出　　处：《中华骨科杂志》2021年第2期123-128,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(11701509,81501912)。

摘　　要：临床上引起腰腿痛的病因较多,一般认为来源于发生退变的椎间盘及周边的韧带和肌肉等组织,其中硬膜外静脉丛曲张是一个长期被忽视的病因。硬膜外静脉丛广泛分布在椎管内侧与硬膜、神经根直接相邻,并作为腔静脉辅助引流系统在体液循环中发挥重要作用。由于骨性椎管容积相对固定,所以若硬膜外静脉丛严重迂曲、扩张则有可能直接挤压硬膜、马尾或者相应节段神经根,导致类似椎间盘突出症或椎管狭窄症的临床症状。因扩张的静脉丛缺乏特异的影像学表现,在临床上很难准确地与椎间盘突出症或椎管狭窄症等相鉴别,故极易被忽视。然而,扩张的静脉丛迂曲且壁薄,术中很容易出血,增加手术难度,同时也会导致如术后硬膜外血肿等相关并发症。虽然对硬膜外静脉丛的研究开展较早,且已经被纳入大多数的解剖学图谱中,但临床医生对于硬膜外静脉丛的解剖结构、形态学特征、临床意义和影像学检查等细节仍然所知甚少。通过对以上几个方面进行文献综述,介绍硬膜外静脉丛的最新研究进展。The epidural venous plexus is considered as a cause of low back and leg pain but has been neglected for a long time.As an auxiliary drainage system of the vena cava,the epidural venous plexus plays an important role in the circulation of body fluids,and its tortuous expansion may lead to clinical symptoms similar to a herniated disc or spinal stenosis,by compressing nerve roots or dura.Due to the lack of specificity of imaging findings,it is difficult to distinguish accurately from disc herniation or spinal stenosis.The epidural venous plexus is tortuous and thin-walled,which is easy to be broken during the operation that resulted in obscuring the surgical field and leading to other complications such as postoperative hematoma.Despite researches of epidural venous plexus have been carried out for years,details are still left unknow.We hereby reviewed the latest research progress of the epidural venous plexus including anatomical structure,morphological characteristics,clinical significance and imaging examination.

关 键 词：椎管狭窄症 静脉丛 硬膜外血肿 椎间盘突出症 临床医生 引流系统 神经根 腔静脉 

分 类 号：R681[医药卫生—骨科学]