骨科
词汇介绍
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解析
Sciatica 英 /saɪ'ætɪkə/ 美 /saɪ'ætɪkə/
释义 n. [内科] 坐骨神经痛
例句 Sciatica is pain, weakness, numbness or tingling that can begin in the lower back and run down even to the toes. 坐骨神经痛是疼痛，乏力，麻木或刺痛，可以开始在腰部和运行下来甚至到了脚趾。
概述
概述
坐骨神经痛是以坐骨神经循行和分布区域的持续性或阵发性疼痛、麻木为主要临床表现的周围神经疾病。由于发病原因及受压部位不同，可分为根性坐骨神经痛和干性坐骨神经痛2种。
病因及病理机制
坐骨神经是全身最大的外周神经，由腰骶干、S1-3神经组成，起始于腰骶部的脊髓，途经骨盆，并从坐骨大孔穿出，经梨状肌下孔出骨盆到臀部，在臀大肌深面向下行，循行至腘窝以前，分为胫神经和腓总神经，支配小腿及足的全部肌肉以及除隐神经支配区以外的小腿与足的皮肤感觉。坐骨神经痛的发病机制与神经根及其感觉神经节的受压有关，也与局部炎症因子浸润有关。
临床表现
由于发病原因的不同坐骨神经痛可突然发生也可缓慢发生。坐骨神经痛疼痛尖锐，并且自臀中部或下部沿着神经向下放射，神经根受压时疼痛在大腿外侧，压迫时疼痛稍向后。L4受压后疼痛位于大腿前外侧，可能会误以为由髋部疾病引起。 不同严重程度的腰痛伴随坐骨神经痛的疼痛特点不一致。骶髂关节疼痛常见于椎间盘破裂。咳嗽、打喷嚏、拉伸等动作增加背部和坐骨神经疼痛表明椎间盘破裂。行走引起的双侧坐骨神经痛和类似血管跛行是马尾根压迫的结果，被称为神经性跛行。
治疗方式
大多数情况下坐骨神经痛能够在不经治疗的情况下自然消退。由于坐骨神经痛有超过90%的患者是由腰椎间盘突出引起的，因此本着治病求本的原则，对腰椎间盘疾病的治疗就显得尤为重要，坐骨神经痛的临床治疗也更多地参考腰椎间盘突出的治疗。
约有3/4的坐骨神经痛患者在3个月后症状开始消退，但是由于疼痛严重降低生活质量，绝大多数患者选择治疗，并且倾向于手术治疗。如果症状符合典型的临床表现并且影像学显示椎间盘破裂，通过腰神经根减压治疗坐骨神经痛最有可能成功。显微椎间盘切除术和各种微创和经皮技术，包括一系列管状牵开器或内镜，常用于治疗椎间盘破裂旧。如果没有移动性腰椎滑脱并且是单节段手术，则通常不需要融合相邻的椎体。微创治疗显示出更早和更好的疼痛缓解趋势，可能是因为椎旁肌损伤较少，但可能需要更长的手术时间。
18F-FDG PET/MRI in Chronic Sciatica: Early Results Revealing Spinal and Nonspinal Abnormalities
复制标题
慢性坐骨神经痛的18F-FDG PET/MRI: 早期结果揭示脊柱和非脊柱异常
发表时间：2017-11-02
影响指数：7.4
作者： Cipriano Peter W
期刊：J NUCL MED
18F-FDG PET/MRI is a novel diagnostic approach that can offer metabolic and structural examinations of painful lesions. Compared with separate acquisition with each modality, simultaneous acquisition with PET and MRI can greatly mitigate motion-induced misregistration. This advantage is significant for specifying pain sources because the common sources of sciatic pain, such as a herniated disk, degenerated facet joints, and impinged spinal nerves, are located very close to one another. The high sensitivity of 18F-FDG PET for metabolically hyperactive foci can be used to detect an abnormal increase in metabolism caused by painful inflammation.A recent PET imaging study demonstrated increased 18F-FDG uptake in injured nerves of rats as well as in denervated calf musculature of the affected limb. Unfortunately, the low spatial resolution and lack of tissue contrast of PET limit distinction among multiple possible pathologies for a detected lesion. The high-resolution anatomic views and superior soft-tissue contrast of MRI can help to resolve the anatomic ambiguity of PET. On the other hand, when multiple or subtle structural abnormalities are detected on MRI, the metabolic contrast on PET can highlight the pain-relevant inflammatory changes within the detected lesions.
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