lumbar hernia
Introduction
Brief introduction Between the 12 ribs and the iliac crest, the abdominal visceral protrudes through the abdominal wall or the posterior peritoneum, called the lumbosacral (1umbarhernia), also known as the back squat. In 1672 Barbotte first reported the disease, and Budden (1728) first reported congenital lumbosacral Galanteot (1731) found the first lumbosacral incarceration at autopsy, and the first lumbosacral repair was performed by Dr. Ravanton (1750). In 1783 Petit described the anatomical boundaries of the lower lumbar triangle and reported it. One patient with lumbosacral incarceration, so the lower waist triangle was named Petit Triangle. Before 1866, the surgeon thought that all the lumbosacral lumps were pulled out from the lower waist triangle, and until Grynfeltt proposed the presence of the upper waist triangle (Grynfeltt triangle), the clinician gradually got a comprehensive understanding of the lumbosacral. The lumbosacral sac is located between the muscles in the waist region and can occur in the upper lumbar triangle or the lower lumbar triangle. It is rare in clinical practice. basic knowledge Sickness ratio: 0.5% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction
Cause
Cause of lumbosacral
Anatomical factors (30%):
The lack of muscle protection in the waist triangle is a congenital factor that causes lumbosacral, accounting for about 19% of the lumbosacral. The waist triangle is the weak area of the abdominal wall, which is composed of the lower waist triangle gap and the upper waist triangle gap. When the wound occurs, or the healing is poor after the lumbar surgery, or the disease causes muscle degeneration, the protection of the muscles and fascia is further reduced, causing major defects in the originally existing anatomical weak area, when the intra-abdominal pressure increases. Even the abdominal viscera is separated from the two gaps to form the lumbosacral.
Trauma (30%):
About 26% of the acquired pathogenic factors are traumatic and procedural, because the wounds in the lower back or partial incisions (such as after nephrectomy) cause poor healing of the lumbar triangle. Because the upper lumbar triangle is relatively constant and the gap is large, the upper lumbar lumbosacral lumbosacral is more common, and the lumbosacral sputum content is mostly small intestine and colon.
Increased intra-abdominal pressure (30%):
Accounted for 55% of lumbosacral cases, mainly chronic cough, long-term constipation, poor urination and other reasons for increased intra-abdominal pressure, induced the disease. Lumbar muscle atrophy, such as waist muscle atrophy caused by sequelae of polio, or obesity muscle atrophy, further reduces the protection of muscles and fascia, and the waist triangle is weaker.
Pathogenesis
Lower lumbar triangle (Petit's triangle): located below the waist, the lower boundary is sputum, the outside is the posterior margin of the external oblique muscle, the inner boundary is the leading edge of the latissimus dorsi, the underside of the triangle is the intra-abdominal oblique muscle, and the surface has a superficial fascia. This triangle is one of the weak areas of the posterior wall of the abdomen due to the lack of sufficient muscle level.
Upper lumbar triangle (Grynfeltt-Lesgaft's triangle): located in the angle between the 12th rib and the erector spinae, in the upper front of the lower lumbar triangle, the inner boundary is the outer edge of the spine, and the upper boundary is the bottom edge of the triangle. The lower edge of the 12 ribs and the lower posterior serratus, the outside is the posterior margin of the internal oblique muscle, the bottom of the triangle is the aponeurosis at the beginning of the transverse abdominis muscle, with the ribbed nerve in front, the inferior phrenic nerve and the inguinal inguinal nerve. Crossing, the top is the latissimus dorsi, the biggest weakness of this triangle is below the 12th rib, where there is only the transverse fascia without the latissimus dorsi.
Prevention
Lumbosis prevention
Avoid or reduce the factors of increased intra-abdominal pressure, such as chronic cough, constipation, etc., such as senile chronic bronchitis, history of senile constipation, should be actively treated, such as chronic bronchitis patients should quit smoking, increase physical exercise, oxygen Treatment can reduce the recurrence of chronic inflammation. Older constipation can increase the intake of fruits, vegetables, yoghurt and honey, can improve intestinal peristalsis, increase intestinal lubricity and reduce avoidance, and avoid causing the increase of abdominal pressure to induce this disease.
Complication
Lumbosacral complications Complications, intestinal obstruction
The sacral neck of the lumbosacral sac is relatively wide, and the incarceration of the sputum content is less likely to occur. The incidence is about 10% of the total lumbosacral sputum. Once the contents of the iliac crest are incarcerated and narrowed, the lumbar mass can not be repaid. And local pain and intestinal obstruction appear.
Symptom
Symptoms of lumbosacral symptoms Common symptoms The soft swelling of the waist of the bowel is slowly increased, the waist is sore and the indigestion is weak.
There are two kinds of congenital and acquired.
1. Congenital lumbosacral sputum is generally found in the lower part of the abdominal muscles when the child is crying. After the last part of the external oblique muscle and the latissimus dorsi, there are half round protrusions, soft and no tenderness. The surface of the skin is normal, and it can touch the intestines located in the tumor. The shape of the organs can be heard and the bowel sounds when pressed. When it is crying, it can be increased. When it is quiet, it can be repaid. After the resection, the oval wall defect can be touched on the lateral abdominal wall. Porosity.
2. Acquired lumbosacral spasm occurs in elderly and thinners. Most patients have no special symptoms. Only a slowly enlarged mass is seen at the waist. The mass of the mass is soft and easy to repay. The mass is obvious when standing, and disappears when lying in the prone position. Local swelling or traction, palpation may have a cough impact, and large lumbosacral may have symptoms such as indigestion.
Examine
Waist examination
1. X-ray examination of the lateral position of the lumbosacral patient X-ray gastrointestinal sputum angiography, visible small intestine or colon into the lumbar mass, is a special means of auxiliary examination.
2. CT scan can find lumbosacral and partial defects.
Diagnosis
Dialysis of lumbosacral
1. The main manifestation is the lumbar reversible mass. Congenital lumbosacral is found by the mother or physician at the time of birth. Adult lumbosacral, with progressive increase over time, may have a history of severe cough, trauma, nephrectomy, and generally no special symptoms, less incarceration.
2. Signs of lumbar and reversible masses with cough and impact.
3. X-ray examination of the lateral X-ray gastrointestinal sputum angiography examination, is helpful for diagnosis.
