腰椎滑脱症椎间融合后出现上位神经根损伤的病因分析  

Analysis of the Causes of Upper Nerve Root Injury in the Treatment of Lumbar Spondylolisthesis Using PLIF Combined with Pedicle Screw Internal Fixation

作　　者：肖善富 张喜善[2] 从先锐 

机构地区：[1]山东省单县东大医院骨科湖西脊柱研究所,单县274300 [2]泰山医学院附属医院骨科,泰安271000

出　　处：《中国现代手术学杂志》2016年第2期126-128,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腰椎滑脱症患者行椎间融合内固定（posterior lumbar interbody fusion,PLIF）术后出现上位神经根损伤的原因、治疗方法及预后。方法 2006年4月-2014年8月,腰椎滑脱症患者228例;平均年龄44（31-66）岁;男122例,女106例。Ⅰ°滑脱163例,Ⅱ°滑脱65例;退变性滑脱144例,峡部裂性滑脱84例;L4滑脱126例,L5滑脱102例。对所有患者行PLIF手术治疗。结果术后出现上位神经根损伤8例,发生率为3.5%。对出现上位神经根损伤患者立即行CT和MRI检查,显示椎弓根螺钉均在椎弓根内;其中1例螺钉位置较靠下,造成椎弓根下壁膨胀,形成神经根管狭窄,压迫神经根;1例神经根管处明胶海绵填塞较多,1例神经根严重水肿增粗,1例椎间融合器稍大,其它原因不明。立即拆开此3例患者的伤口,进行探查,取出填塞较紧的海绵,更换螺钉,扩大神经根管;所有神经根损伤患者均给予甘露醇、甲强龙、非甾体抗炎药物、丹参、维生素B1和甲钴胺等药物治疗,并结合针灸、理疗等治疗。均于6个月内康复。结论腰椎滑脱患者椎间融合术后可能出现上位神经根损伤,其主要原因与手术操作有关。为避免出现上位神经根损伤,操作应轻柔,置钉应准确无误,应尽可能用双极电凝充分止血,减少明胶海绵用量;在撑开椎间隙前,一定要松解上位神经根管,同时不要过度撑开椎间隙,以免损伤神经根。Objective To investigate the mechanism of upper nerve root injury after the treatment of posterior lumbar interbody fusion（ PLIF） combined with pedicle screw internal fixation for lumbar spondylolisthesis. Methods From April 2006 to August 2014,228 cases of lumbar spondylolisthesis in our hospital were treated by PLIF combined with pedicle screw internal fixation. There were 163 cases of Ⅰ°and 65 cases ofⅡ °. There were 144 cases of lumbar degenerative spondylolisthesis and 84 cases of lumbar isthmic spondylolisthesis. There were 126 cases of L4 spondylolisthesis and 102 cases of L5 spondylolisthesis. Results Eight cases appeared upper nerve root injury postoperatively. The incidence was 3. 5%. CT and MRI showed that all pedicle screws were in the pedicel. The screw position was relatively lower in one case resulting in the expansion of the pedicle wall and the nerve root canal stenosis. The gelatin sponge tamponade was found excessive in one case. And the nerve root was severely edema and enlarged in 1 case. These three patients had the wound opened immediately to take the gelatin sponge tamponade out with the enlargement of the nerve root canal,and replacement of the screws. All the patients got rehabilitated in 6 months. Conclusion The postoperative upper nerve root injury may occur in the spondylolisthesis patients undergo intervertebral fusion combined with pedicle screw internal fixation. The main cause is the operative processing. To avoid the upper nerve root injury,the operation should be gently and accurately performed as far as possible with the bipolar electric coagulation hemostasis,and the dosage of gelatin sponge should reduce. Before open intervertebral disc,it should be sure to release the upper nerve root canal,and the excessive distraction of intervertebral disc also should be avoided.

关 键 词：脊柱前移 脊柱融合术 神经损伤 

分 类 号：R687.3[医药卫生—骨科学]