Takahashi K, Kagechika K, Takino T, Matsui T, Miyazaki T, Shima I
Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Japan.
Spine (Phila Pa 1976). 1995 Dec 15;20(24):2746-9. doi: 10.1097/00007632-199512150-00017.
This study was done to assess the pathophysiology of neurogenic intermittent claudication by measuring the epidural pressure at walking.
Changes in epidural pressure during walking in patients with neurogenic intermittent claudication and in normal individuals were analyzed.
Neurogenic intermittent claudication may be caused by compression of the nerve roots or may be a result of nerve root ischemia. The exact pathogenesis of neurogenic intermittent claudication is uncertain.
Local epidural pressure changes at the stenotic level during walking were analyzed in 12 patients with lumber spinal stenosis and seven normal individuals. a flexible pressure transducer was inserted into the epidural space and placed at the L4-L5 level. The epidural pressure was monitored continuously during walking. The pattern of the pressure change was assessed by gait analysis using a foot switch.
The pressure was changed during walking. The pressure had a wave pattern of increase and decrease, and this pattern was repeated during walking. Intermittent pressure increase was seen about 90 times per minute while walking at a velocity of 2 km/h. An increase in epidural pressure occurred at the double-supporting phase in each gait cycle.
The pressure was high in spinal stenosis and low in normal individuals. The increase of epidural pressure at simple walking was higher than walking with lumbar flexion. Intermittent compression to the nerve roots during walking may be a cause of neurogenic intermittent claudication.
本研究旨在通过测量行走时的硬膜外压力来评估神经源性间歇性跛行的病理生理学。
分析神经源性间歇性跛行患者和正常个体行走过程中硬膜外压力的变化。
神经源性间歇性跛行可能由神经根受压引起，也可能是神经根缺血的结果。神经源性间歇性跛行的确切发病机制尚不确定。
分析12例腰椎管狭窄症患者和7名正常个体行走过程中狭窄节段的局部硬膜外压力变化。将一个柔性压力传感器插入硬膜外间隙并置于L4-L5水平。行走过程中持续监测硬膜外压力。使用脚踏开关通过步态分析评估压力变化模式。
行走过程中压力发生变化。压力呈现出上升和下降的波动模式，且在行走过程中重复出现。以2公里/小时的速度行走时，每分钟约出现90次间歇性压力升高。在每个步态周期的双支撑阶段硬膜外压力会升高。
椎管狭窄患者的压力较高，正常个体的压力较低。单纯行走时硬膜外压力的升高高于腰椎前屈行走时。行走过程中对神经根的间歇性压迫可能是神经源性间歇性跛行的一个原因。
