神经根型腰椎病的诊治及早期疗效评价  

Diagnosis,treatment and early outcome evaluation of radicular lumbar disease

作　　者：刘孝文 赵天翌 刘磊 史浩洋 侯洋 史国栋 LIU Xiaowen;ZHAO Tianyi;LIU Lei;SHI Haoyang;HOU Yang;SHI Guodong(Department of Spinal Surgery,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)第二附属医院脊柱外科,上海200003

出　　处：《海军军医大学学报》2024年第11期1439-1443,共5页Academic Journal of Naval Medical University

基　　金：上海市卫生健康委员会卫生行业临床研究专项面上项目(202340128).

摘　　要：目的提出神经根型腰椎病的诊断标准并对其手术治疗效果进行评价。方法对2020年3月至2023年10月我院脊柱外科收治的31例神经根型腰椎病患者进行回顾性研究,记录手术过程中神经根张力的变化,并对患者的手术并发症、视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分及改良MacNab评分进行统计学分析。结果31例神经根型腰椎病患者中男13例、女18例,平均年龄为(56.39±9.96)岁;均接受了改良经椎间孔入路腰椎椎体间融合术(TLIF),其中单节段手术2例,两节段手术22例,三节段手术4例,四节段手术2例,六节段手术1例;随访时间为(15.29±4.34)个月。术中测得神经根张力较高[25.00(22.00,28.25)g],而在手术结束即刻再次测量发现神经根张力下降[2.00(0.00,3.00)g],差异有统计学意义(P<0.01)。术后患者的VAS评分、ODI、JOA评分均较术前改善(均P<0.01)。末次随访时,改良MacNab评分有24例“优”、5例“良”、2例“可”、0例“差”,优良率为93.55%(29/31)。手术并发症包括脑脊液漏和切口感染各1例。结论神经根型腰椎病患者的显著临床特征是神经高张力,此类患者可以通过改良TLIF治疗改善神经的高张力状态,而且早期准确诊断并及时干预是患者获得良好预后的关键。Objective To propose diagnostic criteria for radicular lumbar disease(RLD)and evaluate its surgical outcomes.Methods A retrospective study was conducted on 31 patients with RLD who were admitted to Department of Spinal Surgery of our hospital from Mar.2020 to Oct.2023.The nerve root tension during the operation was recorded,and the surgical complications,visual analog scale(VAS)score,Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA)score,and modified MacNab score were statistically analyzed.Results There were 13 males and 18 females,with an average age of(56.39±9.96)years.All the patients underwent modified transforaminal lumbar interbody fusion(TLIF),including 2 cases of single-level operation,22 cases of two-level operation,4 cases of three-level operation,2 cases of four-level operation,and 1 case of six-level operation.The follow-up duration was(15.29±4.34)months.The nerve root tension during the operation was higher(25.00[22.00,28.25]g),while it decreased immediately after the operation(2.00[0.00,3.00]g),with significant differences(P<0.01).The VAS score,ODI and JOA score after operation were improved compared with those before operation(all P<0.01).At the last follow-up,there were 24 cases of“excellent”,5 cases of“good”,2 cases of“fair”,and no“poor”in the modified MacNab score,and the excellent and good rate was 93.55%(29/31).Surgical complications(including cerebrospinal fluid leakage and incision infection)were occurred in 1 case each.Conclusion The remarkable clinical feature of patients with RLD is high tension of nerve.These patients can be treated by modified TLIF to improve the nerve hypertonia;early and accurate diagnosis and timely intervention are the keys to a good prognosis.

关 键 词：神经根型腰椎病 诊断标准 外科治疗 改良经椎间孔入路腰椎椎体间融合术 神经根张力 

分 类 号：R687.3[医药卫生—骨科学]