对L_3横突综合征引起髋部疼痛的临床分析和诊治思维
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摘要
目的:分析L3横突综合征致髋部疼痛的临床特点及门诊误诊为髋内原发病变的原因,并总结其诊治策略。方法:回顾性分析2015年5月—2016年8月收治的因"髋部疼痛"就诊且被门诊误诊为髋部病变的12例L3横突综合征致髋部疼痛的临床资料。结果:研磨试验均为(-),L3横突压痛9例,同侧竖直肌紧张5例;髋部影像未发现异常,腰骶部X线片提示L3横突肥大7例,腰骶部MRI全部均可见L3横突周围T2高信号水肿影;经仔细体格检查、影像学检查修正5例,经L3横突位置诊断性封闭修正7例,经过一次治疗有所缓解4例,二次治疗有所缓解6例,三次治疗有所缓解1例,三次治疗后仍无缓解1例;随访半年腰部痛点封闭治疗有效率高达91.7%。结论:门诊以髋部疼痛就诊的L3横突综合征患者易被误诊为髋部原发疾病,门诊医生可通过详细的病史询问、规范的体格检查、针对性的影像学检查及诊断性封闭治疗来提高该病门诊的诊断率,横突尖精确痛点封闭注射治疗1个疗程即可收到良好疗效。
Objective: To analyze the clinical characteristics of L_3 transverse process syndrome with hip pain,and the causes of misdiagnosis as the primary lesion of the hip in the clinic,of course also to summarize the diagnosis and treatment strategies. Methods: Retrospectively analyze the clinical data of 12 patients who were admitted to the hospital for hip pain from May 2015 to August 2016 caused by L_3 transverse process syndrome and misdiagnosed as hip disease. Results: Grinding test of them are all positive,Positive tenderness of L_3 transverse process have 9 cases,5 cases of ipsilateral vertical muscle tension,No abnormalities were found in hip images while Lumbosacral X-ray showed 7 cases of L_3 transverse process hypertrophy and the lumbosacral MRI showed all of them have T2 high signal edema around L_3 transverse process. The diagnosis were modified in 5 cases? After carefully physical examination and imaging examination,The diagnosis were modified in 7 cases by L_3 transverse position diagnosis of Closed therapy,after a treatment eased in 4 cases,two treatment eased in 6 cases,three treatment relieved in 1 cases,after three treatment is still no relief in 1 cases. After half a year follow-up,the effective rate of lumbar pain point closure was 91. 7%. Conclusion: L_3 transverse process syndrome patients with hip pain are easily misdiagnosed as primary hip disease,so doctors can improve the diagnostic rate of out-patient through detailed history,canonical physical examination,Targeted imaging and Diagnostic closure therapy. These painters can get good curative effect. After 1 treatment pain point closed injection.
Objective: To analyze the clinical characteristics of L_3 transverse process syndrome with hip pain,and the causes of misdiagnosis as the primary lesion of the hip in the clinic,of course also to summarize the diagnosis and treatment strategies. Methods: Retrospectively analyze the clinical data of 12 patients who were admitted to the hospital for hip pain from May 2015 to August 2016 caused by L_3 transverse process syndrome and misdiagnosed as hip disease. Results: Grinding test of them are all positive,Positive tenderness of L_3 transverse process have 9 cases,5 cases of ipsilateral vertical muscle tension,No abnormalities were found in hip images while Lumbosacral X-ray showed 7 cases of L_3 transverse process hypertrophy and the lumbosacral MRI showed all of them have T2 high signal edema around L_3 transverse process. The diagnosis were modified in 5 cases? After carefully physical examination and imaging examination,The diagnosis were modified in 7 cases by L_3 transverse position diagnosis of Closed therapy,after a treatment eased in 4 cases,two treatment eased in 6 cases,three treatment relieved in 1 cases,after three treatment is still no relief in 1 cases. After half a year follow-up,the effective rate of lumbar pain point closure was 91. 7%. Conclusion: L_3 transverse process syndrome patients with hip pain are easily misdiagnosed as primary hip disease,so doctors can improve the diagnostic rate of out-patient through detailed history,canonical physical examination,Targeted imaging and Diagnostic closure therapy. These painters can get good curative effect. After 1 treatment pain point closed injection.
引文
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[3]焦力刚,奚春阳,徐公平,等.下腰椎上关节突及峡部相关解剖结构的影像学测量[J].中国脊柱脊髓杂志,2012,22(5):439-442.
[4]朱红霞,苏心镜.横突尖端三点阻滞法治疗L3横突综合征48例[J].临床麻醉学杂志,2004,20(9):552-553.
[5]王汉琴,王配军,陈家强,等.腰椎横突的应用解剖[J].中国临床解剖学杂志,2001,19(3):226-232.
[6]杜光生,蓝志坚,屠文龙,等.第3腰椎横突综合征的诊治体会[J].浙江创伤外科,2009,14(6):581-583.
[7]李敏,孙钢,彭兆辉,等.髋部疼痛常见病的磁共振表现[J].医学影像学杂志,2011,21(6):900-904.
[8]叶乐,郑拥军,朱紫瑜,等.超声引导下射频损毁脑脊神经后内侧支治疗腰椎小关节综合征[J].上海医学,2012,35(6):476-479.
[2]卢爱兰.第三腰椎横突综合征81例误诊的原因分析及对策[J].中国骨伤,2010,23(7):565-566.
[3]焦力刚,奚春阳,徐公平,等.下腰椎上关节突及峡部相关解剖结构的影像学测量[J].中国脊柱脊髓杂志,2012,22(5):439-442.
[4]朱红霞,苏心镜.横突尖端三点阻滞法治疗L3横突综合征48例[J].临床麻醉学杂志,2004,20(9):552-553.
[5]王汉琴,王配军,陈家强,等.腰椎横突的应用解剖[J].中国临床解剖学杂志,2001,19(3):226-232.
[6]杜光生,蓝志坚,屠文龙,等.第3腰椎横突综合征的诊治体会[J].浙江创伤外科,2009,14(6):581-583.
[7]李敏,孙钢,彭兆辉,等.髋部疼痛常见病的磁共振表现[J].医学影像学杂志,2011,21(6):900-904.
[8]叶乐,郑拥军,朱紫瑜,等.超声引导下射频损毁脑脊神经后内侧支治疗腰椎小关节综合征[J].上海医学,2012,35(6):476-479.