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頁籤選單縮合
題 名 | High Lumbar Disc Herniations |
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作 者 | 蔡錦鋒; 林君甫; 陳維德; | 書刊名 | 中華民國骨科醫學會雜誌 |
卷 期 | 15:1 1998.03[民87.03] |
頁 次 | 頁46-53 |
專 輯 | 小兒骨科病變專輯 |
分類號 | 416.61 |
關鍵詞 | 腰; Disc herniation; High lumbar disc; |
語 文 | 英文(English) |
英文摘要 | High lumbar disc herniations (L1-2, L2-3,and L3-4) are much less common than the disc lesions of the lower lumbar levels, and there were only a few reports discussed them in detail. We present sixteen patients with high lumbar disc herniation, and discuss their clinical surgical & imaging findings. From April 1992 to April 1997, 16 patients with high lumbar disc herniations confirmed by Myelo-CT or MRI were reviewed retrospectively. There were 13 males and three females. The average age was 49.9 years (ranged from 33 to 69 years old). Duration of symptoms was from 3 days to 10 years. Clinical symptoms and signs indluded back pain, lower extremity pain, and various neurologic deficits of high lumbar root distributions. Fifteen patients received spinal nerve injections to confirm the affect roots. Three patients had disc herniations at L1-2, three at L2-3, and 10 patients at L3-4, including two extraforaminal herniations. Eight of the 16 patients were found to have thoracolumbar Scheuermann's disease. Fourteen patients had combined lower lumbar disc degeneration, the other two had isolated high lumbar disc degeneration and extraforaminal herniations. Six patients were treated conservatively, two of them had sequestrated disc, and four had extruded disc. Ten patients received operation due to intolerable pain and progressive muscle weakness. Six had sequestrated disc, and 4 had extruded disc. High lumbar dis herniations are rare and they presented with various clinical pictures such as lateral thigh pain in L1-2 herniation, knee pain in L2-3 herniation and anterior leg pain in L3-4 herniation. Weak quadriceps, decreased patellar reflex, positive tension sign, and sensory deficits are important neurologic findings. Most patients had coexisting diffuse lower lumbar degeneration and there is a slight increase in the proportion of patients at the older-age group. Preexisting thoracolumbar Scheuermann's disease with subsequent disc degeneration of the upper lumbar discs is one of the probable causes of high A retrospective study was taken to review the result of managemrnt of trigger thumb. One hundred and five patients with trigger thumb were identified by chart review. Ninety-eight of these were assessed and underwent follow-up physical examination. The anomaly had not been seen at birth. Four patients with a single trigger thumb developed the deformity in the opposite hand within several months (2-10 months) after the first trigger thumb had been diagnosed. The condition is acquired rather than congenital. The term `congenital' is a misnomer because patients acquire the deformity after birth. The period of observation averaged 26 months (range 6-72); none of the patients had spontaneous recovery completely. Twently-nine patients eventually requested surgical release; all these patients had a range of movement comparable to the opposite side. Surgical intervention is highly successful for conservative treatment failure. It is unresonable to prolonged period of observation. |
本系統中英文摘要資訊取自各篇刊載內容。