重度腰椎滑脱手术的L_(5)神经根牵张损伤机制  

Mechanism of L_(5) nerve root stretch injury in corrective surgery for high-grade spondylolisthesis

作　　者：杨进[1,2] 孔清泉 吴浩[1] 李韦龙[1] 伍椰 王玉 YANG Jin;KONG Qingquan;WU Hao;LI Wei-long;WU Ye;WANG Yu(Department of Orthopedics Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Spine Surgery,Affiliated Hospital,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]四川大学华西医院骨科,四川成都610041 [2]西南医科大学附属医院脊柱外科,四川泸州646000

出　　处：《中国矫形外科杂志》2021年第17期1573-1578,共6页Orthopedic Journal of China

基　　金：国家老年疾病临床医学研究中心(四川大学华西医院)资助项目(编号:Z2018B07)。

摘　　要：L_(5)神经根损伤的高发生率是重度滑脱手术治疗中的主要关注点和治疗难点之一。文献报道,重度滑脱术后的L_(5)神经根损伤的实质为牵拉伤,牵张力的大小与重度滑脱的病理改变、神经根的力学特性以及复位程度、椎间高度重建及后凸矫正有关,然而,多大牵张力会造成L_(5)神经根损伤仍不清楚。在重度滑脱的手术治疗中,术中神经电生理监测的优势仍不确定。因此,从降低L_(5)神经根损伤的角度,重度L_(5)椎滑脱的部分复位可能是更安全、更合理的选择。The high incidence of L_(5)nerve root injury is one of the main concerns and challenges in the surgical treatment of highgrade spondylolisthesis(HS).It has been reported in the literature that the essence of L_(5)nerve root injury after corrective surgery for HS is traction injury,and the amount of traction tension is related to the pathological changes of HS,the mechanical properties of nerve root,the extent of reduction,the reconstruction of intervertebral height and the correction of kyphosis.However,it is not clear how much tension will lead to nerve root damage,the benefits of multimodal intra-operative monitoring in the surgical treatment for HS remains uncertain.From the perspective of reducing the L_(5)nerve root injury,the partial reduction of HS may be safer and more reasonable.

关 键 词：重度腰椎滑脱 矫正手术 L_(5)神经根损伤 张力 复位 

分 类 号：R687[医药卫生—骨科学]