破裂型腰椎间盘突出症临床特点及影像学诊断.doc

破裂型腰椎间盘突出症临床特点及影像学诊断 　［摘 要］ 目的：探讨破裂型腰椎间盘突出症的临床特点及影像学诊断。方法：收集资料完整的128例腰椎间盘突出症患者,手术证实为破裂型者48例,对患者临床症状、体征、数字X射线摄影(DR)、CT及MRI特点进行分析。结果：破裂型腰椎间盘突出症81.25%有咳嗽时腰腿痛加重,87.50%出现短暂腰痛加重后有明显腿痛,直腿抬高试验lt;40°；DR腰椎前凸及腰椎生理曲度异常62.4%,椎间隙异常83.2%,CT显示边缘模糊,髓核异位,巨大突出及后缘锐角征象,其CT髓核突出率常超过50%；MRI显示脱出髓核周围低信号带亦有较高发生率,髓核脱出率在50%以上,MRI可见椎体后方低信号条状影中断。结论：破裂型腰椎间盘突出症具有症状明显、神经损害重等特点，结合影像学检查征象有助于提高破裂型腰椎间盘突出症。　　［关键词］ 腰椎间盘突出症；破裂型；临床表现；影像学 　　Clinical and Radiological Characteristics of Noncontained Lumbar Disc Herniation 　　　　Abstract：Objective To study the clinical and radiological characteristics of noncontained lumbar disc herniation.Methods We retrospectively reviewed the medical records of 128 patients with lumbar disc herniation who underwent surgery and evaluated the characteristics of clinical signs and symptoms,CT and MRI of noncontained lumbar disc herniation.Results In 128 patients,48 had noncontained lumbar disc herniation.In these 44 patients,80% had aggravated lumbar and leg pain when coughing;86% had intensive leg pain after transient aggravated lumbar pain;the result of the straight leg raising test was patients.In these patients,the rate of disc herniation was more than in CT,and focal interruption of the black line was found in MRI.Conclusion We can establish the diagnosis of noncontained lumbar disc herniation before operation basing on the characteristics of clinical signs and symptoms and manifestation of CT and MRI. 　　Key words：Lubar intervertebral disc protrusion；Noncontained；Clinical manifestation；Imaging 　　破裂型腰椎间盘突出症由于机械压迫和化学性刺激,常出现明显的根性痛,严重影响患者的工作和生活,多需手术治疗，而未破裂型腰椎间盘突出症的患者仅存在机械压迫,症状较轻,可保守治疗或微创介入治疗。治疗方法的选择主要取决于腰椎间盘突出的程度与状态［1,2］,所以术前确定腰椎间盘是否破裂对治疗方法的选择具有重要意义。本文通过对128例腰椎间盘突出症患者的临床影像学特点进行回顾性分析,为术前诊断破裂型腰椎间盘突出症提供一定依据。 　　1 材料与方法 　　1.1 一般资料 自2000年1月至2006年7月在我院手术治疗腰椎间盘突出症患者128例,男99例,女29例,年龄21岁～58岁,平均年龄41.8岁。病程6个月～20 a,平均病程2.5 a。腰椎间盘突出部位为L5～S1 41例,L4～L5 47例,L3～L4 18例,L2～L3 12例,L1～L2 10例。左侧突出58例,右侧突出52例,中央型突出18例。 　　1.2 腰椎间盘突出症的分型 腰椎间盘突出症分为4型:突出型、纤维环下突出型、经纤维环突出型和游离型。后2型属于破裂型,前2型属未破裂型。所有病例均行Love法、半