Goodreau J J, Creasy J K, Flanigan P, Burnham S J, Kudrna J C, Schafer M F, Bergan J J, Yao J S
Surgery. 1978 Dec;84(6):749-57.
Lower extremity pain caused by exercise but relieved by rest is usually a reliable symptom of chronic arterial insufficiency. However, similar discomfort often occurs in patients with neurospinal compression. Furthermore, arterial occlusive disease and demonstrable spinal stenosis may be present simultaneously. Fifty-two patients with symptoms suggesting intermittent claudication comprised the study group. All were proven to have a nonarterial cause of their complaint. The study consists of a retrospective analysis of the diagnostic methods used in confirming the proper diagnosis. Conclusions reached suggest a rational approach to solution of individual patient problems. The nonvascular origin of the symptoms was suggested initially by clinical evaluation in 19 patients, and by noninvasive arterial evaluation in an additional 22. The neurospinal origin of symptoms was obscured in 11 patients because of the presence of significant arterial occlusive disease, as demonstrated by nominvasive arterial testing. Seven of the 11 patients underwent arterial reconstruction, which failed to relieve their symptoms. Subsequently, the neurospinal origin of these symptoms was proven by appropriate treatment. This experience has shown that the errors in diagnosis and treatment could have been avoided by using a combined diagnostic approach, correlating results of an accurate clinical evaluation with noninvasive arterial testing as well as the findings shown on lumbosacral spine films.
运动引起下肢疼痛但休息后缓解通常是慢性动脉供血不足的可靠症状。然而，类似的不适在神经脊髓受压患者中也经常出现。此外，动脉闭塞性疾病和明显的椎管狭窄可能同时存在。52例有间歇性跛行症状的患者组成了研究组。所有患者均被证实其症状存在非动脉性病因。该研究包括对用于确诊的诊断方法进行回顾性分析。得出的结论提示了一种解决个体患者问题的合理方法。症状的非血管性起源最初在19例患者中通过临床评估得以提示，在另外22例患者中通过无创动脉评估得以提示。11例患者的症状神经脊髓起源被掩盖，因为无创动脉检测显示存在严重的动脉闭塞性疾病。11例患者中有7例接受了动脉重建，但症状并未缓解。随后，这些症状的神经脊髓起源通过适当治疗得到证实。这一经验表明，通过采用联合诊断方法，将准确的临床评估结果与无创动脉检测结果以及腰骶部脊柱X光片上的表现相关联，可以避免诊断和治疗中的错误。
