单侧TLIF术后继发对侧神经根症状的原因分析  

Analysis of causes of secondary contralateral radiculopathy after unilateral TLIF and prevention strategies

作　　者：李广彬 王在斌 贺利娜 陈秀民 LI Guang-bin;WANG Zai-bin;HE Li-na;CHEN Xiu-min(The Seventh Orthopedics Department;Orthopedics Department;Anesthesiology Department,Puyang Traditional Chinese Medicine Hospital,Puyang,Henan 457000,China)

机构地区：[1]濮阳市中医医院骨七科,河南濮阳457000 [2]濮阳市中医医院骨科,河南濮阳457000 [3]濮阳市中医医院麻醉科,河南濮阳457000

出　　处：《颈腰痛杂志》2024年第2期325-329,344,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察单侧经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)术后对侧神经根症状的发生情况,分析其原因并提出预防策略。方法回顾性分析2018年1月~2022年1月该院开展的318例单侧TLIF手术患者资料,统计术后1周内的对侧神经根症状发生情况,并给予针对性治疗。将术后出现对侧神经根症状的患者列入症状组,其余患者列入无症状组。统计两组患者术前、术后6个月的腰痛和下肢痛VAS评分和腰椎功能JOA评分;测量两组患者术前、术后的腰椎前凸角(lumbar lordosis,LL)、节段间前凸角(segmental angle,SA),椎间盘前缘高度(anterior disc height,ADH)、椎间盘后缘高度(posterior disc height,PDH)、椎间孔高度(foraminal height,FH)、椎间孔宽度(foraminal width,FW)和椎间孔面积(foraminal area,FA)。对两组患者的上述指标进行比较。结果318例中,术后19例(5.97%)出现新的同一节段对侧神经根症状。其中,因对侧椎间孔狭窄所致10例(52.6%),残余的椎间盘内容物突出至对侧6例(31.6%),血肿形成1例(5.3%),螺钉置入错误2例(10.5%)。12例采用非甾体类抗炎药或神经阻滞后好转,另7例均二次手术后好转。症状组和无症状组患者的人口学资料和临床资料均无统计学差异(P>0.05)。与术前相比,两组患者术后6个月的腰痛、下肢痛VAS评分均显著降低,且JOA评分均显著升高(P<0.05);但两组之间比较,差异均无统计学意义(P>0.05)。与术前比较,症状组患者术后的LL、SA和ADH值均显著增加(P<0.05),PDH、FA和FH值均显著降低(P<0.05)。两组间比较,症状组患者术后的FH、FW和FA值均显著低于无症状组(P<0.05)。结论腰椎退行性疾病行单侧TLIF术后的对侧神经根症状并不少见,但多可通过非手术措施得到缓解。其发生原因,以对侧椎间孔狭窄最为常见,其次为残余的椎间盘组织自对侧突出、压迫神经根所致,也可见置钉错误和血肿压迫所致。Objective To observe the occurrence of contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion(TLIF)and analyze its causes and propose prevention strategies.Methods A retrospective analysis of the clinical data of 318 patients with unilateral TLIF surgery was performed in our hospital from January 2018 to January 2022,the occurrence of contralateral nerve root lesions within 1 week after surgery was counted,and targeted treatment was given.Patients with postoperative contralateral nerve root lesions were included in the symptomatic group,and the remaining patients were included in the asymptomatic group.The VAS scores of lumbar pain and lower limb pain and JOA scores of lumbar spine function were calculated before and 6 months after surgery in both groups;the anterior lumbar lordosis(LL),segmental angle(SA),anterior disc height(ADH),posterior disc height(PDH),foraminal height(FH),foraminal width(FW),and foraminal area(FA)were measured and compared before and after surgery in both groups.Results Of the 318 cases,19(5.97%)developed new contralateral nerve root symptoms in the same segment postoperatively.Among them,10 cases(52.6%)were due to contralateral foraminal stenosis,6 cases(31.6%)had protrusion of residual disc contents to the contralateral side,1 case(5.3%)had hematoma formation,and 2 cases(10.5%)had screw placement errors.Altogether 12 cases got improved with NSAIDs or nerve blocks,and the other 7 cases were all relieved after secondary surgery.There was no statistical difference between the demographic and clinical data of the patients in the symptomatic and asymptomatic groups(P>0.05).Compared with the preoperative period,the VAS scores of low back pain and lower limb pain were significantly lower and the JOA scores were significantly higher in both groups 6 months after surgery(P<0.05);however,there was no statistically significant difference between the two groups(P>0.05).Compared with the preoperative period,the postoperative LL,SA and ADH values significantly increased(P<

关 键 词：腰椎退行性疾病 经椎间孔腰椎椎体间融合术 对侧神经根症状 椎间孔狭窄 单侧减压 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]