(One) Clinical symptoms
1.Lumbago
Is the first symptom to appear in most patients, with an incidence rate of91％. Due to the stimulation of the nucleus pulposus to the outer layer of the annulus fibrosus and the posterior longitudinal ligament, pain is induced in the lower back through the sinus nerve, and sometimes accompanied by pain in the buttocks.
2.Radiating pain in the lower extremities
Although high lumbar intervertebral disc herniation (lumbar2～3.Most patients are lumbar3～4）Can cause sciatica, but it is rare in clinical practice, not enough5％。绝大多数患者是腰4～5.Most patients are lumbar5, Lumbar1～Sacro
3Interspace protrusion, manifested as sciatica. Typical sciatica is a radiating pain from the lower back to the buttocks, posterior thigh, lateral calf, and foot. The pain intensifies during situations that increase abdominal pressure, such as sneezing and coughing. The limb with radiation pain is usually unilateral, and only a few central or central paracentral nucleus pulposus protrusions manifest symptoms in both lower limbs. There are three causes of sciatica: ① The broken intervertebral disc produces chemical substances that stimulate and induce an autoimmune reaction, causing chemical inflammation of the nerve root; ② The protruding nucleus pulposus compresses or stretches the already inflamed nerve root, causing venous return obstruction, further increasing edema, and increasing the sensitivity to pain; ③ The compressed nerve root is ischemic. These three factors are interrelated and mutually exacerbating.
.Cauda equina symptoms
(2) Signs of lumbar disc herniation: Protruding nucleus pulposus or prolapsed, free disc tissue compressing the cauda equina, mainly manifests as urinary and fecal incontinence, abnormal sensation in the perineum and perianal area. Severe cases may have urinary and fecal incontinence and incomplete paralysis of both lower limbs, which is rare in clinical practice.
1.General signs
(1)Lumbar scoliosis: It is a compensatory deformity that alleviates pain by assuming a posture. Depending on the relationship between the location of the nucleus pulposus and the nerve root, the spine bends towards the healthy side or the affected side. If the nucleus pulposus protrudes medially to the spinal nerve root, the spine bends towards the affected side to reduce the tension of the spinal nerve root; conversely, if the protrusion is located laterally to the spinal nerve root, the lumbar spine usually bends towards the healthy side.
（2)Limited lumbar movement: Most patients have varying degrees of limited lumbar movement, especially evident in the acute stage, with the most obvious restriction being forward flexion, as flexion can further promote the posterior migration of the nucleus pulposus and increase the traction on the compressed nerve root.
（3)Pain, tapping and sacrospinalis muscle spasm: The location of pain and tapping is basically consistent with the vertebral interspace of the lesion.80％～90% of cases are positive. Tapping pain is most obvious at the spinous process, caused by vibration of the lesion. The main pressure points are located on the1cm, a radiation pain along the sciatic nerve may occur. About1/3The patient has lumbar sacrospinalis muscle spasm.
2.Special signs
（1The straight leg raise test and the strengthening test: The patient lies on his back, extends his knees, and the affected limb is passively raised. Normal nerve roots have4mm sliding degree, when the lower limb is raised to60° to70° begins to feel discomfort in the popliteal fossa. In patients with lumbar disc herniation, nerve roots are compressed or adhered, reducing or eliminating the degree of sliding, and raising6Sciatica can appear within 0° and is called a positive straight leg raise test. In positive patients, slowly lower the height of the affected limb until the radiation pain disappears. At this point, actively flex the ankle joint on the affected side, and if the radiation pain is诱发 again, it is called a positive strengthening test. Sometimes, due to a large nucleus pulposus, raising the healthy limb can also stretch the dura mater and induce radiation pain in the affected sciatic nerve.
（2The femoral nerve stretch test: The patient assumes a prone position with the knee of the affected limb fully extended. The examiner raises the extended lower limb, bringing the hip joint into hyperextension. Pain in the distribution area of the femoral nerve in the anterior thigh is considered positive when hyperextension reaches a certain degree. This test is mainly used to examine the lumbar2～3και της σπονδυλικής στήλης3～4οι ασθενείς με προβάτωση του δίσκου
3. Εμφανίσεις του νευρικού συστήματος
(1) Διαταραχή της αίσθησης. Η έκφραση της διαταραχής της αίσθησης εξαρτάται από τη θέση της επηρεασμένης ρίζας του νεύρου. Η επίτευξη της θετικής απόκρισης είναι80％以上. Η αρχική έκφραση είναι η υπερευαισθησία της δέρματος, σιγά-σιγά εμφανίζεται η μούδιαση, η κάπνωση και η μείωση της αίσθησης.
(2) μείωση της δύναμης των μυών 70％～75％ των ασθενών εμφανίζουν μείωση της δύναμης των μυών, η σπονδυλική στήλη5Όταν η ρίζα του νεύρου επηρεάζεται, η δύναμη της απόκλισης του αστραγάλου και του δάχτυλου μειώνεται, η σπονδυλική στήλη1Όταν η ρίζα του νεύρου επηρεάζεται, η δύναμη της κάμψης του δάχτυλου και του πέλματος μειώνεται.
(3Αλλαγή της απόκρισης επίσης είναι ένα από τα τυπικά σημεία που εμφανίζονται συχνά σε αυτή την ασθένεια. Σπονδυλική στήλη4Όταν η ρίζα του νεύρου επηρεάζεται, μπορεί να εμφανιστεί δυσλειτουργία της κολπικής απόκρισης, η αρχική έκφραση είναι ενεργή, μετά γρήγορα μετατρέπεται σε μείωση της απόκρισης, η σπονδυλική στήλη5Όταν η ρίζα του νεύρου τραυματίζεται, η απόκριση είναι συνήθως μηδενική. Σκύτι1Όταν η ρίζα του νεύρου επηρεάζεται, υπάρχει δυσλειτουργία της κολπικής απόκρισης. Η αλλαγή της απόκρισης έχει σημαντική σημασία για τη τοποθέτηση της επηρεασμένης ρίζας του νεύρου.
