合并腰椎退变的梨状肌综合征患者29例手术疗效分析  

Surgical curative effect of 29 patients with piriformis syndrome combined with lumbar spine degeneration

作　　者：朱忠培[1] 宋瑞鹏[1] 范道洋 蔡一鸣[1] 王卫东[1] 王利民[1] 刘屹林[1] 廖文胜 Zhu Zhongpei;Song Ruipeng;Fan Daoyang;Cai Yiming;Wang Weidong;Wang Limin;Liu Yilin;Liao Wensheng(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Spine and Spinal Cord Surgery,Henan Provincial People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院骨外科,郑州450000 [2]河南省人民医院脊柱脊髓外科,郑州450000

出　　处：《中华实验外科杂志》2023年第2期369-371,共3页Chinese Journal of Experimental Surgery

摘　　要：目的探讨合并腰椎退变的梨状肌综合征患者手术治疗效果。方法分析2014年至2021年于郑州大学第一附属医院应用经椎间孔椎体间融合术(TLIF)治疗的合并腰椎退变的梨状肌综合征患者29例;根据日本矫形学会评分(JOA)、视觉模拟评分(VAS)、功能障碍指数(ODI)对患者手术前、手术后1周及末次随访进行评分。结果本组29例患者均成功实施TLIF术;手术时间为(116.17±19.50)min;术中出血量为(310±105)ml,患者术后1周JOA评分高于术前[(20.83±2.79)分比(16.17±3.31)分,t=5.797,P<0.05]。患者末次随访VAS评分低于术前[(1.67±0.82)分比(6.33±1.21)分,t=17.169,P<0.05],患者末次随访ODI评分低于术前[(17.00±4.73)分比(34.67±5.35)分,t=13.325,P<0.05]。影像学检查结果显示所有患者手术节段均正常融合,椎间隙骨性愈合情况良好。27例患者接受TLIF处理后相关症状获得明显改善;2例患者接受TLIF处理后,梨状肌综合征相关症状缓解不理想,二次接受"坐骨神经松解术"处理,手术后相关症状缓解满意。结论对于合并腰椎退变的梨状肌综合征患者,TLIF技术可有效改善患者疼痛、JOA评分及ODI指数,也能通过间接减压骶神经丛,使梨状肌综合征的相关症状得到明显的缓解。Objective To investigate the surgical treatment effect of piriformis syndrome in patients with lumbar degenerative disease.Methods The patients with piriformis syndrome combined with lumbar spine degeneration undergoing transforaminal lumbar interbody fusion(TLIF)treament from 2014 to 2021 were reviewed.The symptoms were scored with Japanese orthopaedic association scores(JOA),visual analogue scale(VAS),and disability index(ODI)before and after surgery and at the last follow-up.Results Patients in this group were successfully performed TLIF surgery;with the operation time(116.17±19.50)min and the blood volume during the operation(310±105)ml.The JOA score of the patient 1-week post-surgery was higher than pre-surgery[(20.83±2.79)than(16.17±3.31),t=5.797,P<0.05].Patient’s last follow-up VAS score is lower than pre-surgery[(1.67±0.82)ratio(6.33±1.21),t=17.169,P<0.05],and the patient’s last follow-up ODI score is lower than pre-surgery[(17.00±4.73)ratio(17.00±4.73)ratio(34.67±5.35),t=13.325,P<0.05].Imaging examination showed that all the patients had normal fusion of the surgical segments and good bone healing of the intervertebral space.Of all patients who received TLIF treatment,27 patients gained significant improvement of related symptoms.After TLIF treatment,the symptoms of piriformis syndrome were not alleviated satisfactorily in 2 patients,who received sciatic nerve release treatment twice.The symptoms were alleviated satisfactorily after the second operation.Conclusion The results of this study show that for patients with piriformis syndrome complicated with lumbar degeneration,TLIF technology can not only ameliorate patient pain,JOA score and ODI index,but also significantly alleviate the relevant symptoms of piriformis syndrome by reducing the sacral plexus.

关 键 词：梨状肌综合征 腰椎退变 经椎间孔椎体间融合术 手术疗效 

分 类 号：R687.3[医药卫生—骨科学]