[1]袁伟,郑肖肖,李秀丽,等.复杂腰骶神经根病的临床特征分析[J].中华老年骨科与康复电子杂志,2025,(04):214-221.[doi:10.3877/cma.j.issn.2096-0263.2025.04.004]
　Yuan Wei,Zheng Xiaoxiao,Li Xiuli,et al.Clinical characteristics analysis of complex lumbosacral radiculopathy[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2025,(04):214-221.[doi:10.3877/cma.j.issn.2096-0263.2025.04.004]
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复杂腰骶神经根病的临床特征分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2025年04
页码:
214-221
栏目:
脊柱专题
出版日期:
2025-08-05

文章信息/Info

Title:
Clinical characteristics analysis of complex lumbosacral radiculopathy
作者:
袁伟1; 郑肖肖2; 李秀丽2; 冯新红2
100038 北京，首都医科大学附属复兴医院骨科1；102218 清华大学北京清华长庚医院神经内科2
Author(s):
Yuan Wei1;  Zheng Xiaoxiao2;  Li Xiuli2;  Feng Xinhong2.
1Department of Orthopedics, Fuxing Hospital, Capital Medical University, Beijing100038, China; 2Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing102218, China
关键词:
腰骶神经根;  腰腿痛;  复杂病因;  临床诊断;  预后
Keywords:
Lumbosacral radiculopathy;  Low back and leg pain;  Complex etiology;  Clinical diagnosis;  Prognosis
DOI:
10.3877/cma.j.issn.2096-0263.2025.04.004
文献标志码:
A
摘要:
目的 探讨复杂腰骶神经根病的临床特征，以提高对该类疾病复杂病因的认识。方法 回顾性研究，收集2018年9月至2025年1月于首都医科大学附属复兴医院和清华大学北京清华长庚医院就诊的病因明确的腰骶神经根病患者11例，系统回顾人口学信息、临床基线数据、实验室检查、神经电生理、影像资料和手术过程等资料，总结其临床特征，对其诊治过程进行分析总结。结果 11例患者中男3例、女8例，年龄29～71岁，病程20天至5年。11例患者首发症状为单侧或非对称性腰背疼痛，逐渐出现单侧/双侧下肢局灶性疼痛，随疾病进展出现不同程度的肌无力、肌萎缩，严重者不能独立行走，合并尿便障碍。11例患者首诊均考虑腰椎退行性病变，对症处理后，症状仍加重，最终诊断均为复杂病因的腰骶神经根病。11例患者中2例布氏杆菌病感染，2例结核感染，1例带状疱疹病毒感染，上述5例患者经积极的抗布病、抗结核和抗病毒治疗，临床症状明显缓解。1例经病理证实为粘液乳头状室管膜瘤，手术切除后预后良好。1例因直肠癌复发局部浸润累及腰骶神经根，预后差。1例为宫颈癌放疗后累及腰骶神经根。3例患者经骨穿证实为血液系统疾病，其中1例套细胞淋巴瘤，1例慢性淋巴细胞白血病，1例为急性淋巴细胞白血病。结论 腰骶神经根病作为临床常见一大类疾病，症状多样，病因复杂，其常见病因是腰椎退行性病变，复杂少见原因包括感染、血液肿瘤、盆腔肿瘤和放疗后损伤等。临床上对于常规治疗后症状仍无改善甚至加重的腰腿痛患者，要考虑复杂病因腰骶神经根病的可能，增加必要的辅助检查提高对腰骶神经根病复杂病因的认识对患者的治疗及预后十分重要。
Abstract:
Objective To explore the clinical characteristics of complex lumbosacral radiculopathy in order to enhance the understanding of its complex etiology. Methods A retrospective study was conducted, collecting data from 11 patients with clearly diagnosed lumbosacral radiculopathy who were treated at Fuxing Hospital Affiliated to Capital Medical University and Beijing Tsinghua Changgung Hospital from September 2018 to January 2025. Demographic information, clinical baseline data, laboratory tests, neurophysiological studies, imaging data, and surgical procedures were systematically reviewed. The clinical features were summarized, and the diagnostic and treatment processes were analyzed. Results Among the 11 patients, 3 were male and 8 were female, with ages ranging from 29 to 71 years and disease durations from 20 days to 5 years. The initial symptom in all patients was unilateral or asymmetric low back pain, gradually progressing to unilateral/bilateral focal lower limb pain. As the disease advanced, varying degrees of muscle weakness and atrophy developed, with severe cases leading to an inability to walk independently and urinary/fecal dysfunction. All patients were initially diagnosed with lumbar degenerative disease, but symptoms worsened despite symptomatic treatment. The final diagnoses revealed complex etiologies of lumbosacral radiculopathy. Among the 11 patients, 2 had Brucellosis infection, 2 had tuberculosis infection, and 1 had herpes zoster virus infection. These 5 patients showed significant clinical improvement after active anti-Brucellosis, anti-tuberculosis, and antiviral treatments. One patient was pathologically confirmed to have a myxopapillary ependymoma, with a good prognosis after surgical resection. One patient had lumbosacral radiculopathy due to local infiltration from recurrent rectal cancer, with a poor prognosis. One patient developed lumbosacral radiculopathy after radiotherapy for cervical cancer. Three patients were diagnosed with hematologic diseases via bone marrow biopsy: 1 with mantle cell lymphoma, 1 with chronic lymphocytic leukemia, and 1 with acute lymphocytic leukemia. Conclusions Lumbosacral radiculopathy is a common clinical condition with diverse symptoms and complex etiologies. While lumbar degenerative disease is a common cause, complex and rare causes include infections, hematologic malignancies, pelvic tumors, and post-radiation injury. For patients with lumbosacral pain who do not improve or even worsen after conventional treatment, the possibility of complex lumbosacral radiculopathy should be considered. Increasing the use of necessary auxiliary examinations to improve the understanding of complex etiologies is crucial for patient treatment and prognosis.

备注/Memo

备注/Memo:
基金项目：北京市医管中心扬帆3.0医工结合培育项目（YGLX202331）
更新日期/Last Update: 2026-04-30