椎间孔外型极外侧腰椎间盘突出症的影像诊断漏诊分析  

Analysis of the Missed Diagnosis of the Extraforaminal Lateral Lumbar Disc Herniation

作　　者：蓝艺婷 LAN Yiting(Fuzhou Second Hospital,Fuzhou 350007,China)

机构地区：[1]福州市第二医院,福建福州350007

出　　处：《中国医药指南》2021年第23期55-57,共3页Guide of China Medicine

摘　　要：目的通过对椎间孔外型极外侧腰椎间盘突出症的CT与MRI影像学征象分析,减少对本病的影像诊断漏诊。方法回顾性分析10例经椎间孔镜手术证实、术前影像漏诊的椎间孔外型极外侧腰椎间盘突出症CT与MRI影像学资料,总结其影像学特征。结果10例病例中病变节段总共10个,均为单侧受累,其中6例位于腰4~5椎间盘,3例位于腰5~骶1椎间盘,1例位于腰3~4椎间盘水平。本组10例突出椎间盘组织在CT上密度及MRI信号同髓核,突出椎间盘组织附着于椎体边缘呈丘状、不规则形或三角形,并压迫神经根;突出椎间盘组织平均径约0.62 cm,矢状位上突出椎间盘外上缘至椎间孔上缘距离平均约0.66 cm;横轴位突出椎间盘的最远端至椎体正中部的距离平均约3.07 cm。10例除1例无任何伴随病变,其余合并腰椎骨质退行性改变9例,合并脊柱侧弯5例,合并椎体不稳3例,合并椎间盘突出5例,合并椎间盘膨出4例。结论椎间孔外型极外侧腰椎间盘突出症在日常工作中并不少见,在日常阅片过程中细致观察横轴位椎管外区域及矢状位椎间孔情况,有助于减少漏诊。另外,冠状位腰骶丛外周神经显像清楚显示突出椎间盘压迫神经根,能够显著提高疾病确诊率。Objective To reduce the missed diagnosis of extraforaminal extreme lateral lumbar disc herniation by analyzing CT and MRI imaging signs.Methods CT and MRI imaging data of 10 patients with extraforaminal extreme lateral lumbar disc herniation confirmed by transforaminal endoscopic surgery and missed diagnosis were retrospectively analyzed.Results There were 10 diseased segments in 10 cases,all of which were unilateral involvement,including 6 in L4-5 intervertebral disc,3 in L5-S1 intervertebral disc,and 1 in L3-4 intervertebral disc.The density and MRI signal of 10 cases of herniated intervertebral disc were the same as that of nucleus pulposus.The herniated intervertebral disc attached to the edge of the vertebral body in the shape of hillock,irregular or triangle,and compressed the nerve root;the average diameter of the herniated disc was about 0.62 cm,and the average distance from the outer upper edge of the herniated disc to the upper edge of the intervertebral foramen was about 0.66 cm;the average distance from the distal end of the disc to the middle of the vertebral body was about 3.07 cm.In 10 cases,except 1 case without any accompanying disease,9 cases were complicated with lumbar bone degeneration,5 cases with scoliosis,3 cases with vertebral instability,5 cases with disc herniation and 4 cases with disc bulge.Conclusion Extraforaminal extreme lateral lumbar disc herniation is not uncommon in daily work.In the process of daily film reading,careful observation of the transverse axial extraspinal region and sagittal intervertebral foramen is helpful to reduce missed diagnosis.In addition,coronal lumbosacral plexus peripheral nerve imaging clearly showed that the herniated disc compressed the nerve root,which significantly improved the diagnosis rate of the disease.

关 键 词：腰椎间盘突出症 椎间孔外型 极外侧 

分 类 号：R681.53[医药卫生—骨科学]