腰椎硬膜外脂瘤病導致腿長不等：病例報告及文獻回顧

Lower Limb Length Discrepancy Caused by Lumbar Epidural Lipomatosis-- A Case Report and Review of Literature

郭美惠(Mei-Hui Kuo) ； 梁秋萍(Chau-Peng Leong)

《中華民國復健醫學會雜誌》 25卷2期 (1997/12) Pp. 155-159

摘要

硬膜外脂瘤病是脂肪組織不正常的聚集在硬膜外腔，大多數病人是因服用類固醇過量，內分泌失調所致，也有報告為過度肥胖者的特殊表現。文獻記載中只有少數完全沒有上述危險因子的病例。
本篇報告一位17歲男性病例，因行走姿勢不良至復健科求診，體檢發現兩下肢不等長，左下肢短2公分，造成機能性脊柱側彎，肌電圖檢查發現左側第四對腰神經至第一薦神經根病變，在磁振攝影中始發現為硬膜外脂瘤病。
在治療方面我們只採取墊高左腳鞋跟來改善其機能性脊柱側彎的問題。上述病例經門診追蹤達8個月，沒有進一步神經症狀產生。至於對硬膜外脂瘤病方面，建議病人規則性的門診追蹤，暫不做積極的手術治療。
在復健科門診中，腿長不等或機能性脊柱側彎是常見的問題，由此病例的發現，我們建議對上述問題的進一步評估及檢查是必須的，病人即使沒有肥胖、服用類固醇等因子，硬膜外脂瘤病仍將列入病因的考量，而磁振攝影為此一疾病的最佳檢查。

關鍵字

腰椎硬膜外脂瘤病 ； 腿長不等 ； 機能性脊柱側彎

並列摘要

Epidural lipomatosis is resulted from abnormal accumulation of unencapsulated fat in the epidural space. A case with idiopathic spinal lipomatosis is commonly seen in the following situations: steroid treatment, endocrinopathy, and obesity. Interestingly, a young male without the previous three conditions developed idiopathic spinal epidural lipomatosis. He was observed with lower limb length discrepancy and functional scoliosis.
This patient was diagnosed by the method of magnetic resonance imaging and later received a variety of treatments according to his symptoms. Since there was no progressive neurological deficit, his problem of functional scoliosis was corrected by elevating his left heel by 2 cm.
Lower limb length discrepancy induced functional scoliosis is not uncommon and spinal epidural lipomatosis should be considered as one of the etiologies.

並列關鍵字

epidural lipomatosis ； lower limb length discrepancy ； functional scoliosis