腰椎退变性疾病的神经功能分型及临床意义初探  

Neurological function classification for lumbar degenerative disease and preliminary exploration of its clinical significance

作　　者：侯洋 赵天翌 史洪洋 刘孝文 史建刚 史国栋 HOU Yang;ZHAO Tianyi;SHI Hongyang;LIU Xiaowen;SHI Jiangang;SHI Guodong(Department of Orthopaedics,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200003,China)

机构地区：[1]海军军医大学(第二军医大学)第二附属医院骨科,上海200003

出　　处：《海军军医大学学报》2023年第8期938-944,共7页Academic Journal of Naval Medical University

摘　　要：目的提出一种腰椎退变性疾病(LDD)的神经功能分型,并初步探索其临床意义。方法选取2019年3月至2020年12月海军军医大学(第二军医大学)第二附属医院骨科收治的LDD患者163例,根据相应诊断标准分别将其分为神经根型(50例)、脊髓马尾型(42例)、混合型(38例)、马尾综合征型(7例)和局灶型(26例)。所有患者均采用改良经椎间孔入路腰椎椎体间融合术治疗,统计分析手术临床效果和术后并发症。结果术后随访时间为(19.92±4.95)个月。根据Nakai评定标淮,优68例(41.72%)、良82例(50.31%)、可8例(4.91%)、差5例(3.07%),优良率为92.02%(150/163)。马尾综合征类型的LDD患者中手术效果差的患者比例高于其他各类型LDD,差异有统计学意义(P均<0.05),其余各类型间比较差异均无统计学意义(P均>0.05)。结论根据病史及影像学资料,术前判断LDD的神经功能分型,有助于选择合适的手术方法并取得理想的疗效。Objective To propose a neurological function classification(NFC)for lumbar degenerative disease(LDD)and to preliminarily explore its clinical significance.Methods Totally 163 patients with LDD admitted to Department of Orthopaedics,The Second Affiliated Hospital of Naval Medical University(Second Military Medical University)from Mar.2019 to Dec.2020 were enrolled and divided into the following 5 types according to the corresponding diagnostic criteria:radicular type(n=50),spinal cord and cauda equina type(n=42),mixed type(n=38),cauda equina syndrome type(CEST,n=7),and focal type(n=26).All patients were treated with modified transforaminal lumbar interbody fusion,and the clinical effects and postoperative complications were statistically analyzed.Results The follow-up period was(19.92±4.95)months.According to the Nakai criteria,68 cases(41.72%)were excellent,82 cases(50.31%)were good,8 cases(4.91%)were fair,and 5 cases(3.07%)were poor.The excellent and good rate was 92.02%(150/163).The proportion of patients with poor surgical effects in patients with CEST was significantly higher than those in patients with other types of LDD(all P<0.05),while there was no significant difference among other types(all P>0.05).Conclusion According to the medical history and imaging data,it is helpful to determine the NFC of LDD before operation,so as to select appropriate surgical methods and achieve ideal results.

关 键 词：腰椎退变性疾病 神经功能分型 椎体间融合术 治疗结果 手术后并发症 

分 类 号：R681.5[医药卫生—骨科学]