非典型游离腰椎间盘脱出伴马尾综合征的诊断及手术时机

发布时间：2018-12-13 17:40

【摘要】：[目的]熟悉非典型游离腰椎间盘突出(SLDH)伴马尾综合征(CES)的特殊影像学表现,减少此类特殊急症患者的误诊并探讨其手术时机。[方法]回顾性分析本科2012年8月~2015年6月行手术治疗的非典型SLDH伴CES患者42例。对此类特殊急症患者的影像学资料进行归纳分析与总结。根据发病至手术的时间间隔将其分为三组,其中,24 h内手术的15例(24 h内组);24~48 h内手术的11例(24~48 h组);超过48h的16例(超过48 h组)。采用Oswestry功能障碍指数(ODI)及Gleave泌尿系统恢复标准评估手术疗效,统计并比较三组患者的并发症发生率。[结果]所有患者均得到完整随访,随访时间14~19个月,平均17.6个月。42例患者术前MRI上游离髓核表现为T1像的低信号,T2像的稍高信号(31例)或低信号(11例)。强化MRI中病程在2周以上的12例(29%)患者呈现周边环形强化影。术后3、6个月及末次随访时24 h内组较24~48 h组患者ODI评分差异有统计学意义(P0.05),24~48 h组与超过48 h组差异无统计学意义(P0.05)。依据末次随访疗效,按照Gleave泌尿系统恢复标准,24 h内组患者优良率为93.33%;24~48 h组优良率54.55%;超过48 h组50.00%。24 h内组较24~48 h组差异有统计学意义(P0.05),24~48 h组与超过48 h组比较差异无统计学意义(P0.05)。随访期间24 h组患者未出现并发症;24~48 h组并发症发生率为9.09%;超过48 h组18.75%。[结论]非典型SLDH伴CES患者有其特殊影像学征象,术前必须对其充分熟悉并结合临床资料进行综合性诊断评估。此类特殊急症患者CES的最佳手术时间窗为24 h内,早期手术减压也可减少并发症的发生。
[Abstract]:[objective] to understand the special imaging features of atypical free lumbar disc herniation (SLDH) with cauda equina syndrome (cauda equina) (CES), to reduce the misdiagnosis of these special emergency patients and to discuss the opportunity of operation. [methods] 42 cases of atypical SLDH with CES who underwent surgical treatment from August 2012 to June 2015 were retrospectively analyzed. The imaging data of this kind of special emergency patients were summarized and analyzed. The patients were divided into three groups according to the time interval from onset to operation. Among them, 15 cases were operated within 24 h (within 24 h), 11 cases were operated within 24 h (24 h), and 16 cases were more than 48 h (more than 48 h group). Oswestry dysfunction index (ODI) and urinary system recovery standard (Gleave) were used to evaluate the outcome of the operation and to compare the incidence of complications among the three groups. [results] all the patients were followed up completely, the follow-up time was 14 ~ 19 months (mean 17.6 months). The free nucleus pulposus showed low signal intensity on MRI in 42 patients before operation, and slightly high signal intensity on T 2 image (31 cases) or low signal intensity (11 cases). 12 cases (29%) with course of more than 2 weeks in enhanced MRI showed circumferential circular enhancement. There was significant difference in ODI score between 24 h group and 24 h group (P0.05), but there was no significant difference between 24 h group and more than 48 h group (P0.05). According to the last follow-up, according to the Gleave urinary system recovery standard, the excellent and good rate of the group within 24 hours was 93.33 and 244h, the excellent and good rate was 54.55; More than 48 h group 50.00.24 h group has statistical significance compared with 244h group (P0.05), 244h group and more than 48h group has no statistical significance (P0.05). During the follow-up period, there were no complications in the 24 h group, 9.09 in the 24 h group and 18.75% in the more than 48 h group. [conclusion] atypical SLDH patients with CES have their special imaging signs, they must be fully familiar before operation and combined with clinical data for comprehensive diagnosis and evaluation. The optimal operating time window for CES in such special emergency patients is within 24 hours. Early decompression can also reduce the incidence of complications.
【作者单位】：滨州医学院附属医院;滨州市人民医院;
【基金】：山东省医药卫生科技发展计划项目(编号:2013WS0300)
【分类号】：R687.3

【相似文献】