术前骶管类固醇注射对腰椎融合术后邻近节段退变性疾病行翻修手术的影响  

Clinical Impact of Preoperative Caudal Epidural Steroid Injection on Revision Surgery for Adjacent Segment Disease Following Lumbar Fusion

作　　者：陈龙[1,2] 王小阵 席金涛 吕鹏 汪洋 邓莉 竺义亮 鲁齐林 Chen Long;Wang Xiaozhen;Xi Jintao;Lyu Peng;WangYang;Deng Li;Zhu Yiliang;Lu Qilin(Department of Spine Surgery,Wuhan Integrated Traditional Chinese and Western Medicine Hospital(Affiliated Hospital of Wuhan Sports University),Wuhan 430070,China;Medical School,University of Rostock,Mecklenburg-Vorpommern,Rostock 82475,Germany)

机构地区：[1]武汉中西医结合骨科医院(武汉体育学院附属医院)脊柱外科二病区,武汉430070 [2]罗斯托克大学医学院,梅克伦堡-前波莫瑞州罗斯托克市82475

出　　处：《骨科》2024年第5期428-434,共7页ORTHOPAEDICS

基　　金：湖北省自然科学基金(2023AFB645);武汉中西医结合骨科医院院级科研项目(HGY202201)。

摘　　要：目的评估术前1个月内骶管硬膜外类固醇注射(caudal epidural steroid injection,CESI)对腰椎融合术后邻近节段退变性疾病(ASDis)行后路减压融合内固定术的安全性及临床疗效的影响。方法回顾性分析2015年1月至2022年1月在武汉中西医结合骨科医院因ASDis而行翻修手术(原有内固定取出+后路减压融合固定)治疗的97例病人的病历资料,根据术前是否行CESI分为A组(未行CESI,51例)和B组(行CESI,46例),再根据末次注射距离翻修手术时间分为B1组(≤1个月,21例)、B2组(>1个月,25例)。分析3组病人的手术时间、术中出血量、硬膜囊撕裂、术后感染、其他并发症及融合情况等;比较术前和术后1、3、12、24个月的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI),末次随访时采用李克特量表(五级)评估病人满意度。结果手术时间及术中出血量在3组之间的差异无统计学意义(P>0.05)。A组、B1组和B2组术后VAS评分和ODI均较术前显著改善,差异有统计学意义(P<0.05),但3组之间评分差异没有统计学意义(P>0.05)。术后及随访期间,A组、B1组和B2组术中硬膜囊撕裂分别为4例(7.84%)、2例(9.52%)、2例(8.00%),术后感染行二次清创术者分别为2例(3.92%)、1例(4.76%)、1例(4.00%),予以对症处理后均恢复正常。3组病人术后脑脊液漏及伤口感染的发生率比较,差异均无统计学意义(P>0.05)。所有病人末次随访时均未出现邻椎病及复发迹象,而且末次随访时椎间均已融合。A组、B1组和B2组术后2年随访时均收获了较高的满意率,分别为82.35%(42/51)、80.95%(17/21)、84.00%(21/25),差异无统计学意义(P>0.05)。结论术前1个月内CESI不会增加术中硬膜囊撕裂、出血及术后感染等风险。Objective To evaluate the safety and clinical efficacy of preoperative caudal epidural steroid injection(CESI)within 1 month on revision surgery for adjacent segment disease(ASDis)following lumbar fusion.Methods A total of 97 patients treated with posterior decompression fusion fixation and removal of existing internal fixation for ASDis from January 2015 to January 2022 in Wuhan Integrated Traditional Chinese and Western Medicine Hospital were retrospectively analyzed.Patients were divided into group A(no CESI,51 cases)and group B(CESI,46 cases)based on whether CESI was performed preoperatively.The group B was further subdivided based on the time of the last injection before revision surgery into group B1(≤1 month,21 cases)and group B2(>1 month,25 cases).Surgical time,intraoperative blood loss,dural tear,postoperative infection,other complications and fusion were analyzed.Visual analogue scale(VAS),Oswestry disability index(ODI)preoperatively and at 1,3,12 and 24 months postoperatively were compared,and the 5-point Likert scale was used to evaluate the patients'satisfaction.Results There were no statistically significant differences in surgical time and intraoperative blood loss among the three groups(P>0.05).The postoperative VAS scores and ODI in groups A,B1,and B2 showed significant improvement compared to preoperative levels,with statistical significance(P<0.05).However,there was no statistically significant difference among the three groups(P>0.05).During the postoperative and follow-up period,there were 4 cases(7.84%),2 cases(9.52%),and 2 cases(8.00%)of dural sac tear in group A,group B1,and group B2,respectively.There were 2 cases(3.92%),1 case(4.76%),and 1 case(4.00%)of postoperative infection who underwent secondary debridement surgery,respectively.After symptomatic treatment,all patients recovered.There was no significant difference in the incidence of postoperative cerebrospinal fluid leakage and wound infection among the three groups(P>0.05).At the last follow-up,all patients showed no signs of adj

关 键 词：骶管 类固醇注射 腰椎融合术 邻近节段退变 再手术 

分 类 号：R687.3[医药卫生—骨科学]