Kuraishi Keita, Hanakita Junya, Takahashi Toshiyuki, Minami Manabu, Watanabe Mizuki, Uesaka Toshio, Honda Fumiaki
Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Tsu-city, Japan.
No Shinkei Geka. 2012 Oct;40(10):877-85.
In the clinical diagnosis of lumbosacral radicular symptoms, dermatome maps are commonly used, by which the segmental location of the affected nerve can be determined. However, the diagnosis is often difficult because the pattern of sensory disturbance does not necessarily match the patterns of classical dermatomes, and there are many dermatome maps made by different methods. The author examined the area of pain and numbness in cases of lumbosacral radiculopathy. Clinical features of pain and numbness in consecutive seventy three cases of lumbosacral radiculopathy were investigated (L3: n=13, L4-S1: n=20). Patients of L3 radiculopathy showed symptoms at the upper buttock and ventral surface of the thighs, knees and upper ventral surface of the legs. Patients of L4 radiculopathy showed symptoms at the ventro-lateral surfaces of the thigh and leg. The distinctive region, defined as the region having 100% superimposition, of L4 radiculopathy was the lateral part of the shin. Patients of L5 radiculopathy showed symptoms at the lateral surfaces of the thigh and leg. The distinctive region was the upper buttock. Patients of S1 radiculopathy showed symptoms at the lower buttock, dorso-lateral part of the leg and lateral part of the foot. The distinctive region was the lateral part of the calf. It was found that the regions of pain and numbness formed a continuous band-like zone from thigh to leg in 8% of L3, 45% of L4 and L5, and 35% of S1 radiculopathy. Using a visual analogue scale, the degree of leg pain was more severe than low back pain in 68% of the patients, but in 5% of patients, low back pain was more severe.
在腰骶神经根性症状的临床诊断中，常用皮节图来确定受累神经的节段位置。然而，诊断往往很困难，因为感觉障碍的模式不一定与经典皮节模式相符，而且有许多通过不同方法制作的皮节图。作者检查了腰骶神经根病患者的疼痛和麻木区域。对连续73例腰骶神经根病患者的疼痛和麻木临床特征进行了研究（L3：n = 13，L4 - S1：n = 20）。L3神经根病患者表现出上臀部、大腿前表面、膝盖和小腿前上表面的症状。L4神经根病患者表现出大腿和小腿的前外侧表面症状。L4神经根病的独特区域（定义为有100%重叠的区域）是胫骨外侧部分。L5神经根病患者表现出大腿和小腿的外侧表面症状。独特区域是上臀部。S1神经根病患者表现出下臀部、小腿背外侧部分和足部外侧部分的症状。独特区域是小腿外侧部分。发现在8%的L3、45%的L4和L5以及35%的S1神经根病患者中，疼痛和麻木区域从大腿到小腿形成一个连续的带状区域。使用视觉模拟量表，68%的患者腿痛程度比腰痛更严重，但5%的患者腰痛更严重。
