摘要
目的报道1例腰椎间盘髓核脱出游离至硬膜囊背侧并复习相关文献，总结该病的临床特点及治疗策略等。方法结合文献回顾分析1例腰椎间盘髓核脱出游离患者的临床资料。患者男，65岁。主诉左下肢疼痛、发胀、麻木20d，加重7d。入院后腰椎MRI示L4～5椎管占位。于2015年1月13日在全身麻醉下行“腰后路减压植骨融合内固定术”，术中游离组织送病理检查。结果术后3个月，患者术前不适症状明显改善，左侧股四头肌肌力约Ⅳ级，左侧直腿抬高试验阴性，双侧跟、膝腱反射阳性。术后病理检查证实游离组织为变性髓核组织。结论腰椎间盘髓核脱出游离至硬膜囊背侧临床少见，其MRI常与囊肿、脓肿、肿瘤、血肿相混淆，极易造成误诊；增强MRI表现为“牛眼征”，有助于该病的鉴别诊断；术后病理可明确诊断。该病可采用保守、微创、开放手术治疗，但要严格把握适应证，当出现急性马尾综合征时应积极行开放手术。
Objective To describe a patient with the posterior epidural migration of lumbar intervertebral disc fragment （PEMLIF） and provide systematic literature review , and to analyze the clinical eharaeteristies and treatment of this condition. Methods The clinical data of 1 patient with PEMLIF was retrospectively analyzed in combination with related literature. The patient was presented with left leg pain, swelling, and numbness of 20 days duration. The patient was examined by MR imaging. The scan showed a posteriorly sequestered disc fragment at the L4_5 level. Under a general anaesthetic, the patient underwent posterior lumbar decompression with fusion on January 13, 2015. The posteriorly migrated fragment was removed and sent for pathological examination. Results Three months post-operation, the clinical symptoms were improved significantly. The strength of left quadriceps was about IV level and the straight-leg raising test of left leg was negative. In addition, the deep tendon reflexes were present and symmetrie. Pathological examination demonstrated that the posteriorly migrated fragment was intervertebral disc. Conclusions PEMLIF to the posterior epidural space is a rare event. MR imaging characteristics are difficult to differentiate from cyst, abscess, tumor and hematomas. Enhanced MRI is helpful in differential diagnosis. The diagnosis can be confirmed by pathological examination. Conservative, minimally, open surgery can be selected for treatment. But the therapeutic indications should be master strictly. When cauda equina symptom occurred, an emergency surgery is needed.
出处
《中华解剖与临床杂志》
2016年第4期346-349,共4页
Chinese Journal of Anatomy and Clinics
关键词
髓核
游离
硬膜囊
马尾综合征
Nucleus pulposus
Dissociate
Dural sac
Canda equina symptom
