腰骶椎管外神经根卡压症的诊断和治疗策略  

The diagnosis and treatment of lumbosacral extra-canal nerve root entrapment

作　　者：徐宝山[1] 马信龙[1] Xu Baoshan;Ma Xinlong(Department of Minimally Invasive Spinal Surgery,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医院微创脊柱外科,天津300211

出　　处：《中华骨科杂志》2024年第19期1313-1318,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助项目(82072491);天津市卫生健康委高层次人才工程(TJSHHXXZ-D2-010);天津市卫生健康科技项目重点学科专项(TJW2023XK023)。

摘　　要：近年来随着诊疗技术的进步,腰骶椎管外压迫导致的神经根卡压症被逐渐引起重视。该病患者常伴有横突肥大、高髂棘、关节突关节和髂腰韧带增生、椎间盘极外侧突出等,腰骶三角分型多为1、2型,由于解剖相对复杂,容易漏诊,磁共振弥散张量成像和磁共振神经成像可以显示神经根椎管外卡压情况。手术治疗的主要目的是充分解除神经压迫,包括经椎旁或Wiltse入路经椎间孔腰椎椎体间融合术或显微椎间孔切开术、内镜下减压等。同轴内镜直接置管易挤压损伤神经根,可采用椎间孔开窗入路或椎管外入路双通道内镜漂浮置管,逐步去除致压因素,沿神经根达到充分减压。In recent years,with the advancement of diagnostic and treatment technology,lumbosacral extra-canal nerve root entrapment has gradually attracted attention.Patients often have hypertrophy of the transverse process,high iliac spine,prolif-eration of the articular process joints and iliopsoas ligaments,and extreme lateral herniation of the intervertebral disc,mostly clas-sified as type 1-2 in the lumbosacral triangle,because of which misdiagnosis is not uncommon in clinic.Diffusion tensor imaging and magnetic resonance neurography can display the compressed nerve root.The main purpose of surgical treatment is to fully relieve nerve compression and thus appropriate surgical techniques should be selected based on the site of compression and the clas-sification of the lumbosacral triangle,including paraspinal or Wiltse approach TLIF,micro foraminotomy,and endoscopic decom-pression.Direct introduction of a co-axis endoscopic tube into the narrow space may compress or damage the nerve root;while fora-men fenestration or extra-foraminal biportal endoscopy can be used to sufficiently decompress the nerve root with floating tube.

关 键 词：椎间盘移位 腰骶椎 神经压迫 内窥镜检查 

分 类 号：R687.3[医药卫生—骨科学]