显微镜下神经根袖套成形术治疗Tarlov囊肿的疗效分析  

Nerve root sheath plasty under microscope in patients with Tarlov cysts: an efficacy analysis

作　　者：郑兆聪 魏梁锋 薛亮 陈业煌 刘海云 Zheng Zhaocong;Wei Liangfeng;Xue Liang;Chen Yehuang;Liu Haiyun(Department of Neurosurgery,900^th Hospital of Joint Logistics Team of People's Liberation Army,Fuzhou 350025,China)

机构地区：[1]解放军联勤保障部队第九OO医院神经外科,福州350025

出　　处：《中华神经医学杂志》2020年第10期1008-1013,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨显微镜下神经根袖套成形术治疗Tarlov囊肿的疗效。方法对解放军联勤保障部队第九OO医院神经外科自2016年3月至2019年12月收治的41例症状性Tarlov囊肿患者,行显微镜下神经根袖套成形术治疗(术中行神经电生理监测),并于术前及术后1周、3个月、6个月(或12个月)时应用疼痛视觉模拟评分(VAS)、腰椎Oswestry功能障碍指数(ODI)评估手术疗效。结果41例患者术后1周、3个月、6个月(或12个月)的VAS评分及腰椎ODI均较术前明显降低,且呈逐渐下降趋势,各时间点间比较差异均有统计学意义(P<0.05)。41例患者的中位腰椎ODI改善率为72.7%(58.9%,79.7%),其中ODI改善率>75%(优秀)19例、51%~75%(良好)14例、26%~50%(尚可)3例、≤25%(较差)5例,总优良率为80.5%(33/41)。术后发生脑脊液漏2例,但无感染;术后第3天1例因交通孔缝扎线松脱引起囊肿复发,经再次手术后无复发。结论术中神经电生理监测下行显微镜下神经根袖套成形术能安全、有效地解除Tarlov囊肿对神经根的压迫,症状缓解率高,复发率低。Objective To explore the curative efficacy of nerve root sheath plasty under microscope in treatment of patients with Tarlov cysts.Methods A total of 41 patients with symptomatic Tarlov cysts,admitted to our hospital from March 2016 to December 2019,were collected;these patients received surgical treatment by nerve root sheath plasty under microscope and neuroelectrophysiological monitoring.The microsurgical efficacy was evaluated by changes of pain visual analogue scale(VAS)scores and lumbar Oswestry dysfunction index(ODI)before and one week,3 months,and 6(or 12)months after surgery.Results The VAS scores and lumbar ODI of 41 patients one week,3 months,and 6(or 12)months after surgery were significantly reduced as compared with those before surgery,and presented a gradually decreased trend,with statistically significant differences between each time point(P<0.05).The median of improvement rate of lumbar ODI was 72.7%(58.9%,79.7%):curative effect was excellent in 19 patients(improvement rate of lumbar ODI>75%),good in 14 patients(51%≤improvement rate of lumbar ODI≤75%),passable in 3 patients(26%≤improvement rate of lumbar ODI≤50%),and poor in 5 patients(improvement rate of lumbar ODI≤25%),enjoying rate of excellent and good curative effect as 80.5%(33/41).Postoperative cerebrospinal fluid leakage occurred in two patients without infection.Cyst recurrence occurred in one patient on the 3rd d of surgery due to loosening of the suture of the access hole,and no recurrence occurred after the second surgery.Conclusion The compression of Tarlov cysts on nerve root can be safely and effectively relieved by nerve root sheath plasty under microscope and neuroelectrophysiological monitoring;the symptom relief rate is high and it is not easy to recur.

关 键 词：Tarlov囊肿 神经根袖套成形术 显微外科手术 

分 类 号：R651[医药卫生—外科学]