腰椎间盘综合征的介绍
腰椎间盘位于两个椎体之间，是一个具有流体力学特性的结构，由髓核、纤维环和软骨板三部分构成。接下来小编为大家整理了腰椎间盘综合征的介绍，希望对你有帮助哦!
Esntials of Diagnosis
诊断要点
Low back pain radiating into the thigh， leg， and foot.
下腰背痛放射至大腿、小腿及足部
Parestheasia in the affected dermatome.
受累区皮肤感觉异常
General Considerations
概述
Relap of low back pain may or may not be associated with leg pain. Patients who prent with low back and leg pain frequently recall earlier episodes of postexertional pain limited to the low back. Though specific evidence is lacking， the pattern of leg pain developing condarily has led many clinicians to attribute the initial episode of localized low back pain to early degeneration of the annulus. With annulus degeneration， the nucleus pulposus bulges into the defect， causing further concentration of stress on the damaged fibers. The annulus is richly innervated with painfibers， and further degeneratinon tends to be associated with more frequent and more inten episodes of pain. Locking and stiffness characterize the painfree periods. Degeneration continues with alteration in the collagen stucture of both the annulus and the nucleus， culminating in fibrosis and unclear fragmentation. The shock-absorbing capacity of the nucleus is diminished， and forces are transmitted in a progressively irregular fashion. Fragments of the deteriorating nuclesus are pushed out ward against or through the weakened annulus， which tends to be weakest at the lateral margin of the posterolongitudinal ligament. The protrusion begins as a posterolateral bulge that caus variable compression and irritation of neural structures.
下腰背痛复发不一定伴有小腿疼痛。有下腰背及小腿痛的病人常回忆以前在用力后疼痛，其部位限于下腰背部。虽然缺乏特征的证明，继发的腿部疼痛已导致许多临床医生将局限性的下腰背痛的最初发作归咎于纤维环的早期变性，因纤维环变性，髓核向缺失部突出，使应力进一步集中在受损的纤维上。纤维环内有丰富的痛觉神经纤维，进一步变性使疼痛发作更频繁更强烈。无痛期间的特征是固定和僵凝，变性持续下去，纤维环和髓核的胶原结构发生变化并以纤维化及髓核碎裂告终。髓核吸收震荡能力下降，作用力逐渐以不规则的形式传导，受损髓核的碎片被推向外，碰着或突破微弱的纤维环，并使后纵韧带侧缘变得最薄弱。髓核开始在后外侧突出，引起不同程度的神经结构受压和刺激。
The contents of the neurl tube bbelow the first lumbar gment consist of nerve roots only. Each nerve root emerges below its respective vertebra. The L4-5 and L5-S1 disk levels correspond to the region of maximal mechanical stress in the lumbar spine. Disk protruions at the levels are likely to involve the portion of the root above the exit at the next lower interspace. Lesions affecting the L5 and S1 nerve roots account for over 90% of disk-mediated nerve root lesions.
在第一腰椎节段以下的椎管内只有神经根，每个神经根在各自的椎体下方突出。腰4~5及腰5~骶1椎间盘水平面相当于腰脊柱中最大的机械应力区域。此平面的椎间盘突出可累及到下一个椎间隙出口以下的神经根，椎间盘突出影响到腰5及骶190%以上的神经根病变是因此而造成的。
Clinical Findings
临床表现
a. Symptoms and Signs： Sciatica， or pain radiating down the leg， is the most common prentation. Prenting complanints of the patient with established diskogenic back pain are remarkable for radicular symptoms. Prolonged compression results in nerve root inflammation and pain referred in a dermatomal distribution. The ont of leg pain is usually insidious， but pain may begin acutely when sudden disk hernia tion follow injury.
a.症状及体征：最常出现的是坐骨神经痛，即向下放射至小腿的疼痛。有椎间盘源性的背
痛病人，神经根症状是明显的，长期压迫导致神经根炎症及疼痛牵涉到皮节分布区，小腿疼痛常常不知不觉的发作。但伤后的突发椎间盘突出，疼痛也可以急性开始。
Pain is piercing and typically radiates from the thigh into the leg and foot. Activities such as coughing， sneezing， or bearing down during bowel movements increa intra-abdominal pressure， which is directly transmitted to intraspinal structures， provoking or exacerbating pain.
疼痛为刺痛，并典型的的由大腿移至小腿及足部、咳嗽、打喷嚏或用力排便等活动增加腹内压时，压力可直接传导致脊柱内结构，而可激起或加重疼痛。
When nerve root compression results from annular bulging， it is often accentuated by prolonged sitting or standing and relieved at least partially by rest. Apatient usually prefers to sleep on one side in the fetal position and when stiting prefers a straight-back chair. When disk extrusion occurs， pain may be less responsive to rest.
由纤维环突出导致的神经根受压时，常常在久坐或久远站后疼痛加重，休息后至少可使疼
痛部分缓解，病人更喜欢侧卧。坐时宁愿坐一直背椅，当椎间盘突出发生时，疼痛对休息的反应不显著。
Compression of nerve roots often produces objective nsory changes early， with paresthesia and loss of nsating detectable in the affected dermatome. With continued root compression. Motor weakness may develop. With involvement of the L4 root， the patellar tendon reflex may be diminished and slight quadriceps weakness may be obrved. Sensation may be diminished over the medial calf. With involvement of the L5 5 root， weakness is frequently manifested by loos of strength in great toe dorsiflexion. Pain and numbness are prent in the anteromedial leg and foot. First sacral root involvement affects the calf musles， and the Achilles reflex may be lost on the involved side. Weakness is best demonstrated by the patient's inability to ri on the toes repeatedly. Sensory findings include pain and numbness in the posterolateral leg and foot. Muscle atrophy may accompany nsory and motor changes.
神经根受压常很早即产生客观的感觉变化，在受影响的皮节区有感觉异常及感觉缺失，神
经根持续受压，可发生运动肌无力，若累及腰4神根，可见膝腱反射减弱和轻度股四头肌无力，小腿肌肉感觉减退。当腰5神经根受累时，常表现为 趾背伸无力，小腿前内侧及足出现疼痛和麻木。骶1神经根受累时，影响小腿肌肉。受累侧跟腱反射消失，病人不能反复用足尖踮立，感觉症状包括小腿后外侧和足有疼痛及麻木感。伴随着感觉和运动肌的变化。可出现肌肉萎缩。
Occasionally， acute posterior midline disk prolap at the L2-3 level may cau compression of many nerve roots in the cauda equina. This is known as acute cauda equina syndrome. This is a surgical emergency! Symptoms include inten leg pain in one or both extremities， with vere muscle weakness or paralysis. Compression of sacral roots results in acute urinary retention. Decompression of the cauda equina is undertaken after mylographic confirmation of the lesion.
偶尔在腰2~3水平后正中位的椎间盘急性脱出，可使马尾部许多神经根受压。此即解性马尾神经综合征。这是一种外科急症。其症状有一侧或两侧小腿的剧烈疼痛，并有严重的肌肉无力或瘫痪。骶神经根受压导致急性尿潴留。脊造影证实有病变后，可作马尾减压术。
b. Diagnostic Test： With less well defined signs of root compression， veral tests may help to detect the prence of lumbar disk dia. The straight leg-raising test is performed by lifting the extended leg of the supine patient. The test produces tension in the lumbosacral roots and frequently reproduces sciatica in the prence of inflamed or irritated lumbosacral roots.
