脊柱痛风累及椎间盘致神经压迫患者行单侧双通道内镜手术治疗1例报告及文献复习

摘要/Abstract

摘要：

脊柱痛风常累及关节突关节，可能在椎管内形成痛风石，但侵袭椎间盘组织进而压迫神经导致患者出现神经根性症状少见文献报道。本文作者报道1例脊柱痛风累及椎间盘致神经压迫患者的临床资料，并结合相关文献进行分析。患者，男性，37岁，以腰部疼痛伴右下肢疼痛不适7年加重2周为主要临床表现，既往痛风病史10年，尿酸水平控制欠佳，下腰部棘突及棘突旁轻度压痛，右下肢直腿抬高试验阳性，右侧髂腰肌肌力Ⅲ级，右小腿外侧浅感觉减退。尿酸水平292.2 μmol·L^-1，CT示腰5椎体下终板及骶1椎体上终板可见骨质破坏，间盘内可见散在分布高密度影。磁共振成像（MRI）示腰5骶1腰椎间盘突出，腰5椎体下终板和骶1椎体上终板见不规则信号影。初步诊断为“腰椎间盘突出症、脊柱痛风、痛风”，行单侧双通道内镜下腰椎间盘切除术，切除间盘组织病理学检查回报明确诊断为脊柱痛风，术后给予止疼和降尿酸等对症治疗。术后3个月门诊随访，患者腰疼及下肢疼痛已完全缓解。脊柱痛风的表现常与间盘突出和椎管内占位性病变症状相似，可表现为腰部疼痛及下肢疼痛。对疑似的患者行MRI检查，有助于脊柱痛风的早期诊断和早期治疗。

关键词: 脊柱痛风, 单侧双通道内镜技术, 痛风石, 腰椎间盘切除, 关节突关节

Abstract:

Spinal gout often involves the facet joints and may form tophi in the spinal canal， but the studies about disc tissue involvement and compressing nerves and causing radicular symptoms in the patients were rare. The clinical materials of one spinal gout patient with intervertebral disc involvement and nerve compression were reported， and the relevant literatures were analyzed. The patient， male， 37-year-old， had low back pain accompanied by right lower limb pain and discomfort for 7 years， aggravated for 2 weeks.The patient had a 10-year history of gout with poorly controlled uric acid levels. The physical examination results revealed mild tenderness over the lower lumbar spinous process and paraspinal area， a positive straight leg raise test on the right side， grade Ⅲ muscle strength in the right iliopsoas muscle， and reduced superficial sensation over the lateral right calf. The uric acid level was 292.2 μmol·L?1. The CT examination results showed bone destruction at the lower endplate of the L5 vertebra and the upper endplate of the S1 vertebra， with scattered high-density shadows within the disc. The magnetic resonance imaging （MRI） results revealed L5 and S1 lumbar disc herniation and irregular signal shadows at the lower endplate of L5 and the upper endplate of S1. The initial diagnosis was “lumbar disc herniation， spinal gout， and gout”. The unilateral biportal endoscopic lumbar discectomy was performed. The pathological examination results of the resected disc tissue confirmed the definite diagnosis of spinal gout. The postoperative symptomatic treatment， including pain relief and uric acid reduction， was administered. At the 3-month postoperative follow-up， the patient’s low back pain and lower limb pain had completely resolved. The manifestations of spinal gout are often similar to those of disc herniation and intraspinal space-occupying lesions， and can include low back pain and lower limb pain. MRI examination in the suspected patients is helpful for the early diagnosis and treatment of spinal gout.

Key words: Spinal gout, Unilateral biportal endoscopy, Tophi, Lumbar discectomy, Facet jornts

中图分类号:

R681.5

刘艺,孟庆广,胡格吉勒,曲扬. 脊柱痛风累及椎间盘致神经压迫患者行单侧双通道内镜手术治疗1例报告及文献复习[J]. 吉林大学学报(医学版), 2025, (): 1-7.

Yi LIU,Qingguang MENG,Gejile HU,Yang QU. Spinal gout patient with intervertebral disc involvement and nerve compression treated with unilateral biportal endoscopic surgery: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2025, (): 1-7.

图/表 2

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