侧方入路腰椎椎间融合术治疗腰椎管狭窄症伴马尾神经冗余征的疗效分析
Clinical outcome of lateral lumbar interbody fusion in the treatment of lumbar spinal stenosis with redundant nerve roots
董吕鹏 1王章富 1冯兴兵 1陈伟富 1陈海啸 1洪正华1
作者信息
- 1. 浙江省台州医院脊柱外科 317000 临海市
- 折叠
摘要
目的:探讨侧方入路腰椎椎间融合术治疗腰椎管狭窄症伴马尾神经冗余征(redundant nerve roots,RNRs)的临床疗效.方法:回顾性分析 2018 年 1 月～2022 年 7 月在我院接受侧方入路腰椎椎间融合术治疗 48例腰椎管狭窄症伴马尾神经冗余征的病例资料,男 23 例,女 25 例,年龄 45～81 岁,平均 65.4±7.5 岁,接受单节段手术 17 例,多节段手术 31 例.患者术前及术后均进行腰椎MRI扫描,按术后的RNRs是否解除分为RNRs解除组(A组)与RNRs未解除组(B组).测量两组患者术前术后马尾神经冗余节段的椎间隙高度、椎间隙角度、椎管横截面积等指标进行影像学评估.术前和术后 1 个月时采用疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分评估手术疗效.结果:所有患者均顺利完成手术.A组术前的椎管横截面积为 65.2±21.5mm2,B组为 35.9±11.5mm2,两组间有显著性差异(P＜0.05).A组术后的椎间隙后缘高度和椎管横截面积分别为 8.3±1.7mm和 92.6±25.8mm2,B组分别为 6.0±2.3mm和 45.4±12.1mm2,两组间比较均有显著性差异(P＜0.05).术后 1个月A组的腿痛VAS评分、ODI和JOA评分分别为 2.4±0.8 分、(24.1±3.0)%和 22.8±1.9 分,B组分别为 3.3±0.8 分、(30.2±4.4)%和 17.7±2.5 分,两组间比较均有显著性差异(P＜0.05).术后的并发症发生率为 10.4%,出现大腿前方疼痛 4 例,腰大肌肌力减退 1 例,均在术后 3 个月随访时完全缓解.结论:侧方入路腰椎椎间融合术可通过椎间隙后缘高度的恢复和椎管横截面积的扩大消除马尾神经冗余现象,为大多数腰椎管狭窄症伴马尾神经冗余征患者提供有效的治疗方式.
Abstract
Objectives:To investigate the clinical efficacy and outcome of lateral lumbar interbody fusion in the treatment of lumbar spinal stenosis(LSS)with redundant nerve roots(RNRs).Methods:The data of 48 LSS patients with RNRs(23 males and 25 females,aged 45-81 years,on average 65.4±7.5 years)treated with lat-eral lumbar interbody fusion between January 2018 and July 2022 in our hospital were analyzed retrospec-tively.Among the patients,17 cases received single-level surgery and 31 cases received multi-level surgery.On the basis of the postoperative supine MRI scans,the patients were divided into RNRs relieved group(group A)and RNRs unrelieved group(group B).Radiographic assessments included disc heights,segmental angle and cross-sectional area of the spinal canal at the RNRs segment before and after operation were per-formed.The visual analogue scale(VAS),Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score were used to evaluate the clinical outcomes at preoperation and 1 month after surgery.Results:All patients underwent surgery successfully.The preoperative cross-sectional area of the spinal canal was 65.2±21.5mm2 in group A and 35.9±11.5mm2 in group B,with a significant difference(P＜0.05).The posterior disk height and cross-sectional area of the spinal canal was 8.3±1.7mm and 92.6±25.8mm2 respectively in group A,and that of group B was 6.0±2.3mm and 45.4±12.1mm2 respectively,the differences were significant-ly statistical(P＜0.05).Furthermore,in 1 month after operation the VAS leg pain,ODI and JOA scores was 2.4±0.8,(24.1±3.0)%and 22.8±1.9 respectively in group A,and that of group B was 3.3±0.8,(30.2±4.4)%and 17.7±2.5 respectively,the differences were significantly statistical(P＜0.05).The total incidence of complications was 10.4%,including anterolateral thigh pain in 4 cases and hip flexor weakness in 1 case,which were released at 3 months of follow-up.Conclusions:Lateral lumbar interbody fusion can eliminate RNRs by restoring postoperative posterior disc height and enlarging the cross-sectional area of spinal canal,which provides an effective treatment for most LSS patients with RNRs.
关键词
腰椎/椎管狭窄症/马尾神经冗余/脊柱融合术Key words
Lumbar spine/Spinal stenosis/Redundant nerve roots/Spinal fusion引用本文复制引用
基金项目
浙江省公益技术应用社发领域项目(LGF21H060008)
出版年
2024
NETL
NSTL
万方数据