腰骶神经根变异分型的研究进展  

The research progress of the variation of lumbosacral nerve root

作　　者：李云昊 程云忠 刘铁[3] 石旭寅 Li Yunhao;Cheng Yunzhong;Liu Tie;Shi Xuyin(Beijing ChaoYang Hospital,Capital Medical University,Beijing 100020,China;Department of Neurobiology,School of Basic Medical Sciences,Capital Medical University,Beijing 100069,China;Department of Orthopaedic Surgery,Beijing ChaoYang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院,100020 [2]首都医科大学基础医学院神经生物学系,100069 [3]首都医科大学附属北京朝阳医院骨科,100020

出　　处：《中华骨科杂志》2021年第12期808-814,共7页Chinese Journal of Orthopaedics

摘　　要：腰骶神经根变异(lumbosacral nerve root anomalies,LNRA)是指腰骶部神经根在形态、走行和起始位置上出现异常,可能与胚胎期神经根的异常迁移有关。影像学检查是目前常用于对LNRA进行定位、定性诊断的方法。临床上基于影像学结果、尸检结果及术中观察制定了许多分型系统,但是缺乏对每种分型系统优、缺点的评价,不利于指导临床工作的开展。因此,对国内外的LNRA分型及其各自的特点进行综述,并评价各分型系统的优势以及局限性。通过对文献的检索汇总,基于影像学结果设计的相应分型不够可靠,不仅是作为首选检查方法,MRI的检出率就远低于尸检结果,且不是对病变的直观研究,真实性上也存疑;基于尸检结果的分型系统,研究中直接将脊髓剥离,排除了周围软组织和脊柱骨性结构的干扰,更有利于对变异进行全面观察,对临床具有一定的指导意义;基于术中观察结果的分型系统,研究样本数量大、易获取,还有相匹配的影像学资料进行后续的对比研究,其中Neidre分型更是目前应用最广泛的分型,对临床工作提供了相当的便利。LNRA可能由于如今技术上的限制和认识上的不足,并未被当作一种常见病来对待,特异性症状的缺乏以及合并压迫才会出现症状的特点更是影响了检出率。在治疗上,传统的椎间盘切除和椎管减压已经不能满足临床需求,更多新型的手术方式亟待提出以改善患者预后,提高生活质量。Lumbosacral nerve root anomalies(LNRA)refers to the abnormality of lumbosacral nerve root in morphology,course and initial position,which may be related to the abnormal migration of nerve root in embryo.Imaging examination is a commonly used method for localization and qualitative diagnosis of LNRA.Clinically,many classification systems have been established based on imaging results,autopsy reports and Book observations.However,the lack of evaluation on the advantages and disadvantages of each classification is not conducive to the development of clinical work.In this paper,the classification and characteristics of LNRA at home and abroad were reviewed,and the advantages and limitations of each classification were evaluated.Through the literature retrieval and summary,it is not reliable to design the corresponding classification based on the imaging results.Not only is the detection rate of MRI as the preferred examination method far lower than that of autopsy,but also it is not an intuitive study of the lesions,and its authenticity is questionable.Based on the classification of autopsy results,the spinal cord is directly stripped in the study,excluding the surrounding soft tissue and bone marrow.The interference of spinal bone structure is more conducive to the comprehensive observation of variation,which has a certain guiding significance for clinical;based on the classification of intraoperative observation results,the number of research samples is large,easy to obtain,and there are matching imaging data to do the follow-up comparative study,among which the Neidre classification is themost widely used classification,which provides considerable convenience for clinical work.LNRA may not be treated as a common disease due to the limitation of technology and lack of understanding.The lack of specific symptoms and the characteristics of combined compression will affect the detection rate.In terms of treatment,traditional discectomy and spinal canal decompression cannot meet the clinical needs.More new surgical met

关 键 词：尸检结果 临床需求 骨性结构 椎间盘切除 特异性症状 神经根 椎管减压 起始位置 

分 类 号：R687.3[医药卫生—骨科学]