腰椎间盘突出症致急性臀上皮神经位移的临床研究  

Acute superior cluneal nerve displacement caused by lumbar disc herniation

作　　者：冯伟 冯子鹤 王飞 刘洪波 安建鹏 王雅蓉 FENG Wei;FENG Zihe;WANG Fei;LIU Hongbo;AN Jianpeng;WANG Yarong(Department of TCM Manipulative Orthopedic,Air Force Medical Center,Beijing 100142;Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]空军特色医学中心中西医结合正骨科,北京100142 [2]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《空军航空医学》2022年第6期316-319,共4页AVIATION MEDICINE OF AIR FORCE

基　　金：军队后勤科研重点项(BKJ17J006);空军军医大学课题(2019ZTA03)。

摘　　要：目的发现腰椎间盘突出症并急性臀上皮神经位移的临床特点、探索其发病机制,初步总结临床对策。方法回顾性分析2021年5月—2022年5月在空军特色医学中心中西医结合正骨科接受治疗的Ⅰ或Ⅱ型腰型腰椎间盘突出症患者60例,其中不伴急性臀上皮神经位移患者50例(A组),伴位移患者10例(B组)和Ⅲ或Ⅳ型腰型腰间盘突出症患者21例(C组)。研究14 m步行用时、起坐用时、直腿抬高试验结果、疼痛视觉模拟量表评分、脊柱功能障碍评分、椎间盘向突出程度、脊柱X线Cobb角度数等指标。结果B组治疗期间主、客观临床症状显著改善(P<0.05);A组及B组入院时症状差异有统计学意义(P<0.05),B组根性征轻,起坐行走能力严重受限;B组及C组之间影像学差异有统计学意义(P<0.05),B组侧弯及椎间盘突出程度轻。结论某些腰椎间盘突出症患者,单(多)个椎体位移后,脊柱内外平衡紊乱,应力集中于臀上皮神经处,若遇合适外力造成患者臀上皮神经损伤位移。并以臀部及下肢痛,起坐艰难、跛行或强迫搀扶行走为主要临床表现。治疗分为新医正骨疗法复位臀上皮神经和纠正椎体位移两步骤。Objective To study the clinical features,pathogenesis,and treatments of lumbar disc herniation with acute superior cluneal nerve displacement.Methods The clinical data of 60 patients with typeⅠorⅡlumbar disc herniation(LDH)treated with Feng's spinal manipulation method at Air Force Medical Center between May 2021 and May 2022 was retrospectively analyzed,including 50 patients without acute superior cluneal nerve displacement(group A)and 10 patients with the displacement(group B).Another 21 patients with typeⅢorⅣLDH treated in the same period served as group C.Such indicators as the 14-meter walking time,sitting and standing time,straight leg raising test results,pain visual analog scale scores,the Oswestry Disability Index score,degrees of intervertebral disc herniation and the Cobb angle of the spine from an X-ray were recorded.Results The subjective and objective clinical symptoms of patients in group B were significantly improved during treatment(P<0.05).The symptoms of patients in group A and group B were significantly different before treatment(P<0.05).Patients in group B had mild radicular symptoms and severely limited mobility.There was significant difference in imaging between group B and group C(P<0.05).The degrees of scoliosis and intervertebral disc herniation in group B were mild.Conclusion Some patients with lumbar disc herniation are vulnerable to disorder of internal and external balance of the spine after the displacement of a single vertebra or multiple vertebrae,so that the stress is concentrated in superior cluneal nerves.Severe limited mobility with hip and lower limb pain are the main clinical manifestations.The treatment should be divided into two steps:the Feng's spinal manipulation to reset the superior cluneal nerve and correct the displacement of vertebrae.

关 键 词：腰椎间盘突出症 急性臀上皮神经位移 新医正骨 椎体位移 脊柱内外平衡 

分 类 号：R684[医药卫生—骨科学]