微创经椎间孔腰椎椎间融合术中神经根和硬膜损伤的原因分析与预防策略  

Cause analysis and preventive strategy for nerve root and dural injuries in minimally invasive transforaminal lumbar interbody fusion

作　　者：王洪伟[1] 李铠湘 王青云[1] 刘晓强[1] 李锐冰 谷昌伟 赵湘军[1] WANG Hong-wei;LI Kai-xiang;WANG Qing-yun;LIU Xiao-qiang;LI Rui-ring;GU Chang-wei;ZHAO Xiang-jun(Department of Orthopaedic Surgery,Dongguan Tungwah Hospital,Dongguan,Guangdong 523110,China)

机构地区：[1]东莞东华医院脊柱外科,广东东莞523110

出　　处：《中国骨与关节损伤杂志》2022年第11期1131-1135,共5页Chinese Journal of Bone and Joint Injury

基　　金：广东省自然科学基金项目(2017A030313894);东莞市社会发展科技项目重点项目(20211800905382)。

摘　　要：目的 研究分析微创经椎间孔腰椎椎间融合(Minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)术中神经根及硬膜损伤的特点和原因,探讨此类并发症的预防和治疗策略。方法 回顾性分析自2015-01—2018-06采用MIS-TLIF手术治疗的350例单节段腰椎退行性疾病,总结其中30例神经根及硬膜损伤的特点和原因,提出预防措施。结果 350例均获得随访,随访时间平均28.5(12~38)个月。350例中30例(8.57%)发生神经根或硬膜损伤,所有神经根或硬膜损伤均进行了相应处理。18例(5.14%)出现硬膜损伤,其中10例直接在原术野中进行硬膜修补,5例改为开放术野进行硬膜修补,3例因裂口较小未进行修补。12例(3.43%)出现神经根损伤,其中5例椎弓根钉置入存在误差,2例术中即刻进行椎弓根钉调整,3例术后复查发现后再次手术调整椎弓根钉位置;2例术后复查时发现存在骨块卡压神经根,再次手术取出卡压骨块;1例神经根断裂行开放神经根吻合术;4例进行非手术对症治疗。5例调整椎弓根钉后4例神经损伤症状完全恢复,1例神经损伤症状改善;2例卡压骨块取出后神经损伤症状完全恢复,1例神经根断裂修复术后神经损伤症状未恢复;4例非手术治疗的患者中,3例神经损伤症状恢复,1例神经损伤症状改善。结论 MIS-TLIF手术中神经根和硬膜损伤的原因既有单一因素也有多因素,临床医师要重视神经根和硬膜损伤的预防,既要不断提高手术技术,重视神经根和硬膜损伤的高危病种和再手术的高危因素,也要明确腰椎病理改变导致的安全三角局部解剖关系的变化,从各个环节预防神经根和硬膜损伤发生。Objective To analyze the characteristics and causes of the nerve root and dural injuries during minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) and to investigate the prevention and treatment strategies for such complications.Methods Three hundred and fifty patients with single-segment lumbar degenerative disease treated with MIS-TLIF surgery were retrospectively analyzed from January 2015 to June 2018. The characteristics and causes of nerve root and dural injuries in 30 cases were summarized and preventive measures were provided.Results The mean follow-up time was 28.5(12-38)months in 350 patients. Nerve root or dural injury occurred in 30 cases(8.57%). Among the 18 cases of(5.14%) dural injuries,dural repair was performed directly in the original field in 10 cases, 5 cases were converted to open field for dural repair, and 3cases were not repaired due to small fissures. Among the 12 cases(3.43%) of nerve root injuries, 5 cases were due to errors in the placement of the pedicle nail(2 cases with immediate intraoperative adjustment of the nail and 3 cases with reoperative adjustment of the nail position after postoperative review);in 2 cases, the nerve roots were found to be stuck by bone blocks on postoperative review, and the stuck bone blocks were removed by reoperation;in 1 case, an open nerve root anastomosis was performed for nerve root rupture;the remaining four cases of nerve root injury were treated with non-operative symptomatic treatment. Among all 12 cases of nerve root injury, 4 cases had complete recovery of nerve injury symptoms and 1 case had improvement of nerve injury symptoms after adjustment of the pedicle nail in 5 cases;2 cases had complete recovery of nerve injury symptoms after removal of the stuck bone block and 1 case had no recovery of nerve injury symptoms after nerve root fracture repair;among the 4 patients treated non-operatively, 3 cases had recovery of nerve injury symptoms and 1 case had improvement of nerve injury symptoms.Conclusion The causes of nerve root

关 键 词：腰椎退行性疾病 微创经椎间孔腰椎椎间融合术 神经根损伤 硬膜损伤 

分 类 号：R681.5[医药卫生—骨科学]