【摘要】：[目的]熟悉非典型游離腰椎間盤突出(SLDH)伴馬尾綜合征(CES)的特殊影像學表現(xiàn),減少此類特殊急癥患者的誤診并探討其手術(shù)時機。[方法]回顧性分析本科2012年8月~2015年6月行手術(shù)治療的非典型SLDH伴CES患者42例。對此類特殊急癥患者的影像學資料進行歸納分析與總結(jié)。根據(jù)發(fā)病至手術(shù)的時間間隔將其分為三組,其中,24 h內(nèi)手術(shù)的15例(24 h內(nèi)組);24~48 h內(nèi)手術(shù)的11例(24~48 h組);超過48h的16例(超過48 h組)。采用Oswestry功能障礙指數(shù)(ODI)及Gleave泌尿系統(tǒng)恢復(fù)標準評估手術(shù)療效,統(tǒng)計并比較三組患者的并發(fā)癥發(fā)生率。[結(jié)果]所有患者均得到完整隨訪,隨訪時間14~19個月,平均17.6個月。42例患者術(shù)前MRI上游離髓核表現(xiàn)為T1像的低信號,T2像的稍高信號(31例)或低信號(11例)。強化MRI中病程在2周以上的12例(29%)患者呈現(xiàn)周邊環(huán)形強化影。術(shù)后3、6個月及末次隨訪時24 h內(nèi)組較24~48 h組患者ODI評分差異有統(tǒng)計學意義(P0.05),24~48 h組與超過48 h組差異無統(tǒng)計學意義(P0.05)。依據(jù)末次隨訪療效,按照Gleave泌尿系統(tǒng)恢復(fù)標準,24 h內(nèi)組患者優(yōu)良率為93.33%;24~48 h組優(yōu)良率54.55%;超過48 h組50.00%。24 h內(nèi)組較24~48 h組差異有統(tǒng)計學意義(P0.05),24~48 h組與超過48 h組比較差異無統(tǒng)計學意義(P0.05)。隨訪期間24 h組患者未出現(xiàn)并發(fā)癥;24~48 h組并發(fā)癥發(fā)生率為9.09%;超過48 h組18.75%。[結(jié)論]非典型SLDH伴CES患者有其特殊影像學征象,術(shù)前必須對其充分熟悉并結(jié)合臨床資料進行綜合性診斷評估。此類特殊急癥患者CES的最佳手術(shù)時間窗為24 h內(nèi),早期手術(shù)減壓也可減少并發(fā)癥的發(fā)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.
【作者單位】： 濱州醫(yī)學院附屬醫(yī)院;濱州市人民醫(yī)院;
【基金】：山東省醫(yī)藥衛(wèi)生科技發(fā)展計劃項目(編號:2013WS0300)
【分類號】：R687.3

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