CAJ | 학술논문

目的探讨腰骶丛神经根性损伤的临床分型.方法 2004年11月至2011年8月,共为36例创伤性腰骶丛神经根损伤患者进行腹膜后腰神经丛及(或)盆腔内骶神经丛及(或)腰骶管神经根手术探查.男24例,女12例；年龄7～49岁,平均29.5岁.伤后时间为2～36个月,平均9.3个月.对每例患者术中探查的神经根损伤情况与其术前临床表现、物理查体一并进行分析、归纳,总结出不同组合的腰骶丛神经根联合损伤的临床表现特点并进行临床分型.结果将腰骶丛神经根损伤分为六型:腰骶丛神经根完全损伤型(L1～S3)4例,腰丛+上骶丛损伤型(L1～S1)6例,骶丛神经损伤型(L4～S3)9例,上骶丛损伤型(L4～S1)11例,下骶丛损伤型(S2,3)4例,腰丛神经损伤型(L1-4)2例.全腰骶丛神经根损伤型、腰丛+上骶丛损伤型及骶丛神经根损伤型者共19例,73.7％(14/19)的损伤部位位于椎管内,且均发生神经根的断裂或撕脱.而上骶丛、下骶丛及腰丛神经根损伤共17例,其中64.7％(11/17)的损伤部位在盆内段及(或)骶前孔处,均为挫伤或牵拉伤.结论上述临床分型基本涵盖腰骶丛神经根损伤的常见类型,为腰骶丛神经根损伤范围的判定提供科学依据.此外,不同类型的腰骶丛神经根损伤,其损伤部位及性质明显不同,对顶后的判定及治疗方案的选择具有重要意义.
목적 탐토요저총신경근성손상적림상분형.방법 2004년11월지2011년8월,공위36례창상성요저총신경근손상환자진행복막후요신경총급(혹)분강내저신경총급(혹)요저관신경근수술탐사.남24례,녀12례；년령7～49세,평균29.5세.상후시간위2～36개월,평균9.3개월.대매례환자술중탐사적신경근손상정황여기술전림상표현、물리사체일병진행분석、귀납,총결출불동조합적요저총신경근연합손상적림상표현특점병진행림상분형.결과 장요저총신경근손상분위륙형:요저총신경근완전손상형(L1～S3)4례,요총+상저총손상형(L1～S1)6례,저총신경손상형(L4～S3)9례,상저총손상형(L4～S1)11례,하저총손상형(S2,3)4례,요총신경손상형(L1-4)2례.전요저총신경근손상형、요총+상저총손상형급저총신경근손상형자공19례,73.7％(14/19)적손상부위위우추관내,차균발생신경근적단렬혹시탈.이상저총、하저총급요총신경근손상공17례,기중64.7％(11/17)적손상부위재분내단급(혹)저전공처,균위좌상혹견랍상.결론 상술림상분형기본함개요저총신경근손상적상견류형,위요저총신경근손상범위적판정제공과학의거.차외,불동류형적요저총신경근손상,기손상부위급성질명현불동,대정후적판정급치료방안적선택구유중요의의.
Objective To classify the type of lumbosacral plexus nerve root injury.Methods From November 2004 to August 2011,36 patients suffered with lumbarsacral plexus nerve root injury underwent surgical exploration in our department.There were 24 males and 12 females,aged from 7 to 49 years(average,29.5 years).By inductively analyzing the location and amount of nerve root injury,preoperative clinical manifestations and results of physical examination,the clinical typing of lumbarsacral plexus nerve root injury was made.Results Lumbosacral plexus nerve root injury was classified into 6 types:total lumbosacral plexus nerve root injury (4 cases),lumbar plexus and upper sacral plexus nerve root injury (6 cases),sacral plexus nerve root injury (9 cases),upper sacral plexus nerve root injury (11 cases),lower sacral plexus nerve root injury(4 cases) and lumbar plexus injury(2 cases).There were 19 patients with total lumbosacral plexus nerve root injury,lumbar plexus and upper sacral plexus nerve root injury or sacral plexus nerve root injury,among which 73.7％(14/19) nerve root injury located in the spinal canal and all of them were nerve root avulsion or rupture.There were 17 patients with upper sacral plexus nerve root injury,lower sacral plexus nerve root injury or lumbar plexus nerve root injury,among which 64.7％ (11/17) nerve root injury located in intro-pelvic or pelvic sacral foramina,and all of them were distraction injury.Conclusion This clinical typing is useful for the accurate diagnosis of lumbosacral plexus nerve root injury.In addition,it is also beneficial for judging the location and characteristics of nerve root injury.