经椎间孔腰椎椎间融合术后对侧神经根性症状的原因分析  

Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion

作　　者：徐道亮[1] 陈教想 金海明[1] 宣俊[1] 王向阳[1] 徐华梓[1] 池永龙[1] Xu Daoliang Chen Jiaoxiang fin Haiming Xuan Jun Wang Xiangyang Xu Huazi Chi Yonglong(Department of Orthopaedic Surgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Chin)

机构地区：[1]温州医科大学附属第二医院骨科,325027

出　　处：《中华骨科杂志》2017年第3期145-152,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81371988）;浙江省医药卫生重大科技计划（WKJ-ZJ-1527）;浙江省大学生新苗人才计划（2016R413072）

摘　　要：目的探讨经椎间孔腰椎椎间融合（Transforaminal lumbar interbody fusion，TLIF）术后对侧神经根性症状的发生率及危险因素。方法回顾性分析2010年1月至2014年1月接受单侧TLIF的腰椎退行性疾病患者587例，男334例，女253例；年龄19-71岁，平均57．1岁。根据术后是否出现对侧神经根症状将患者分为有症状组和无症状组，通过两组影像学资料分析出现症状的可能原因。比较两组手术前后对侧椎间孔面积、节段前凸角及其差值。采用疼痛视觉模拟评分（visual analogue scale，VAS）和13本整形外科学会（Japanese Oahopaedic Association，JOA）腰椎评分评估疗效。结果术后随访9-21个月，平均15．1个月。TLIF术后出现对侧神经根性症状28例，发生率4．8％（28／587）。单节段27例，双节段1例。术前诊断为腰椎管狭窄13例，退变性腰椎滑脱伴椎管狭窄7例，腰椎峡部裂伴滑脱6例，复发性椎间盘突出2例。原因为对侧椎间孔狭窄16例（57．1％，16／28），螺钉位置不良5例（17．9％，5／28），对侧侧隐窝狭窄和（或）椎间盘突出加重3例（10．7％，3／28），术后血肿1例（3．6％，1／28），骨水泥压迫1例（3．6％，1／28），不明原因2例（7．1％，2／28）。19例在保守治疗无效后接受翻修术，翻修率3．2％（19／587）。有症状组手术前后对侧椎间孔面积差值为（-13．8±13．2）mm^2，节段前凸角差值为7．0°±9．8°，与无症状组比较差异有统计学意义。两组术后3个月疼痛VAS评分的差异无统计学意义；JOA腰椎评分改善率无症状组为63．0％±18．1％，有症状组为46．7％±20．1％，差异有统计学意义（t=-3．784，P〈0．05）。结论腰椎TLIF术后出现对侧神经根性症状的发生率为4．8％，可能的危险因素主要包括对侧椎间孔狭窄和螺钉位置不良。提示应严格掌握单侧TLIF手术适应证，避免在未有效增加椎间Objective To analyze the incidence and risk factors of contralateral radiculopathy in patients after unilateral transforaminal lumbar interbody fusion （TLIF） surgery. Methods A retrospective study was conducted within 587 patients （average age 57.1 years, range 19-71 years） who underwent unilateral TILF from January 2010 to January 2014 in our hospital, including 334 males and 253 females. Patients were divided into a symptomatic group and an asymptomatic group. The causes of contralateral neurological symptom were evaluated according to the radiological data. The difference of pre- and post-operative contralateral foramen area （CFA）, segmental angle （SA） and the clinical treatment outcomes （VAS, JOA score） were compared between two groups. Results Patients were followed up for 9-21 months, average 15.1 months. Post-operative contralateral radiculopathy occurred in 28 （4.8%） of the patients who underwent unilateral TLIF, including contralateral foraminal stenosis in 16 （57.1%, 16/28）, screw malposition in 5 （17.9%, 5/28）, contralateral lateral recess stenosis and/or newly developed disc herniation in 3 （10.7%, 3/28）, hematoma in 1 （3.6%, 1/28）, cement compression in 1 （3.6%, 1/28）, and unknown origin in 2 patients （7.1%, 2/28）. Nineteen （3.2%, 19/587） of the 28 patients received revision surgery because of ineffective conservative treatment. Compared with the asymptomatic group, the difference of pre-and post-operative CFA was significantly smaller （-13.8±13.2 mm^2） in symptomatic group, while the SA was significantly greater （7.0°±9.8°） in symptomatic group. The JOA score at 3 months after the surgery was significantly improved in asymptomatic group （63.0%±18.1%, P〈0.05）. Conclusion The incidence rate of contralateral neurological symptom was 4.8% in the present study. The potential risk factors associated with contralateral radiculopathy were predominantly contralateral foraminal stenosis and screw malposition. The excessive restoration of S

关 键 词：腰椎 脊柱融合术 手术后并发症 神经根病 

分 类 号：R687.3[医药卫生—骨科学]