腰痛与腰椎间盘突出症(英文)培训资料.ppt

Protrusion of the L3/4 disc Femoral nerve traction test Central protrusion of a lower lumbar disc It can press on the cauda equina lead to urinary retention. On examination there is usually perianal numbness and a patulous anus. Emergency decompression is essential to avoid permanent damage to sphincter innervation. Central disc protrusion Following a central disc protrusion, which can occur without an antecedent history of back pain, cauda equina compression occurs, often in an abrupt fashion. Severe pain results, with paravertebral localization or with radiation into both lower limbs. Typically, there is severe distal lower limb weakness with foot drop, depression of the ankle reflexes and impaired sphincter function. Saddle anaesthesia is common. 中央型 Occasionally the protrusion is central, pressing on the cauda equina and affecting autonomic control of the bladder leading to urinary retention. Urgent surgical decompression of the cauda equina is required as an emergency. CIinicaI Presentation Any maneuver that increases intraspinal pressure, such as straining at stool, coughing, or sneezing, may exacerbate symptoms. In over half the patients with sciatica from an HNP, a specific nerve root can be identified, simply by history. Weakness: the tibialis anterior---go downstairs, the gastrocnemius soleus muscle group --- going upstairs difficult. 临床表现 流行病学 常见于20～50岁患者 男女比4～6:1 多有弯腰劳动或长期坐位工作史 症状 腰痛 坐骨神经痛 马尾神经受压 体征 腰椎侧突 腰部活动受限 压痛及骶棘肌痉挛 直腿抬高试验及加强实验 神经系统表现 Treatment Not all patients suffer pain As outer disc distorts, may protrude into spinal canal May lead to sciatica (pain down back of leg) Often start with conservative, non-operative care Spontaneous resolution of sciatica often occurs Patients with cauda equina syndrome require surgical attention Common surgical procedures include: Laminectomy, discectomy, microdiscectomy, endoscopic discectomy,