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腰骶神经根造影封闭的应用 |
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张晓阳 冈岛行一 汤杰
【摘要】 目的 探讨神经根造影封闭对腰椎间盘突出症和椎管狭窄症的诊疗意义。方法 对59例根性症状明显者作选择性神经根造影。结果 6例穿刺失败，41例显影异常，于造影后即作封闭，观察 6个月无感染和神经根损伤。神经根异常图像在椎间盘突出多为椎体上缘或小关节突内缘充盈缺损中断，椎管狭窄时以边缘不整像为主。根据封闭提示对多节段椎间盘突出作单节段有限手术。结论 该方法可作为椎间盘突出及椎管狭窄的影像和功能诊断手段，封闭有一定治疗作用。
【关键词】脊神经根；脊髓造影术；封闭疗法；腰椎间盘突出症；椎管狭窄
【中图分类号】 R681.53 【文献标识码】 A
【文章编号】 1008-0287(2000)03-0174-03
Application of lumbosacral radiculography and blocking
Zhang Xiaoyang,Yukikazu Okajima,Tang Jie
(Dept of Orthopaedics,Shanghai Minhang Central Hospital,Shanghai 201100)
【Abstract】 Objective To explore the clinical significance of radiculography and blocking in lumbar disc herniation and spinal canal stenosis. Methods Selective radiculography was performed in 59 cases of obvious radicular symptoms. Results Puncture failed in 6 cases, while abnormal image was found in 41 cases for whom blocking was applied. No infection and injury of nerve root were found during 6 months of observation. In disc herniation, the abnormal radiculographs showed mainly filling defects and interruption on the superior margin of the vertebra or the interior margin of the facet joint, while in spinal canal stenosis, the abnormality was largely irregular margin. In multisegmental disc herniation, monosegmental limited surgery was performed on the basis of suggestion from blocking. Conclusion This procedure is effective for imaging and functional diagnosis of disc herniation and spinal canal stenosis, and blocking has certain therapeutic value.
【Key words】spinal nerve roots;myelography; blocking therapy; lumbar disc herniation; spinal stenosis
腰骶神经丛结构复杂，腰骶椎变异多，退变发生早而明显，病变时常使神经根受累产生根性症状。神经根造影（radiculography）不但可用于形态学诊断，还可同时封闭注射，并根据造影诱发痛和封闭效果作出神经根的功能诊断，且神经根封闭也有一定的治疗作用。鉴于神经根造影所具有的独特意义，目前仍是一种以根性症状为主疾患的诊疗方法。笔者对造影显示的神经根异常图像进行分析，着重探讨其与临床表现、术中所见及封闭疗效的对应关联，以揭示其对下腰痛疾患，尤其是腰椎间盘突出症（特别是多节段间盘突出）和椎管狭窄症的诊疗价值。
1 材料与方法
1.1 病例资料 1993年7月～1995年12月共施行腰骶部脊神经根造影59例。男37例，女2[1] [2] 下一页
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