后柱截骨短缩联合椎间融合治疗腰骶神经弓弦病的临床观察  

Clinical observation of posterior column osteotomy and shortening by interbody fusion in the treatment of lumbosacral nerve bowstring disease

作　　者：牛源青 王辉[1] 霍亚冲 刘庆涛 袁鸿儒 徐佳欣[1] NIU Yuanqing;WANG Hui;HUO Yachong;LIU Qingtao;YUAN Hongru;XU Jiaxin(Department of Spinal Surgery,The Third Hospital of Hebei Medical University,Shijiazhuang 050051)

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《颈腰痛杂志》2025年第2期330-333,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨后柱截骨短缩术(PCO)联合椎间融合治疗腰骶神经弓弦病的临床疗效。方法回顾性分析2018年1月至2020年3月期间住院手术的21例腰骶神经弓弦病患者临床资料。记录患者的手术时间、术中出血量以及脊柱短缩距离。神经功能评估采用Oswestry功能障碍指数(ODI)问卷,局部腰椎前凸角度定义为手术责任节段椎间隙的夹角。结果本组共完成21例手术,完成了半年以上的随访,其中L_(4/5)(17名患者)、L_(5)/S_(1)(4名患者)。单节段PCO联合椎间融合平均的后凸矫形为21.4°,脊柱短缩平均0.8 cm,术前患者ODI评分为29.95±2.52,术后半年随访患者ODI评分为17.43±5.56,术后大多数患者ODI较术前明显改善(P<0.05)。18例患者术后半年随访时,神经症状较术前改善(改善组);3例患者症状并未改善亦无加重(未加重组)。未改善组均以鞍区麻木和大小便障碍为主诉,而改善组中16例(88.9%)以下肢感觉异常为主诉,仅2例(11.1%)以鞍区麻木和大小便障碍为主诉。结论后柱截骨短缩联合椎间融合治疗腰骶神经弓弦病临床疗效满意,尤其对于以下肢感觉运动障碍者,对于以马尾神经障碍患者的疗效还有待于进一步观察。Objective To investigate the clinical effect of posterior column osteotomy(PCO)combined with interbody fusion in the treatment of lumbosacral arch string disease.Methods The clinical data of 21 patients with lumbosacral nerve bowstring disease who were surgically treated from January 2018 to March 2020 were retrospectively reviewed.The operation time,intraoperative blood loss,and spinal shortening distance of the patients were recorded.Neurological function was assessed using the Oswestry Disability Index(ODI)questionnaire,and the local lumbar lordosis angle was defined as the angle between the intervertebral spaces at the level of responsibility for surgery.Results A total of 21 operations were completed in this group,and the follow-up for more than half a year was completed,including L_(4/5)(17 patients)and L_(5)/S_(1)(4 patients).The average kyphosis correction of single-segment PCO combined with interbody fusion was 21.4 degrees,and the average spinal shortening was 0.8 cm.The preoperative ODI score of the patients was 29.95±2.52,and the ODI score at the 6-month postoperative follow-up was 17.43±5.56.The ODI of most patients after operation was significantly improved compared with that before operation(P<0.05).During the six-month follow-up after surgery,the neurological symptoms of 18 patients were improved compared with those before surgery(improved group);the symptoms of 3 patients were neither improved nor aggravated(without reorganization).In the unimproved group,the main complaints of sellar area numbness and bowel and bladder disturbance were the main complaints,while in the improved group,16 cases(88.9%)complained of lower limb paresthesia,and only 2 cases(11.1%)had the main complaints of sellar area numbness and bowel and bladder disturbance.Conclusion Posterior column osteotomy combined with interbody fusion is a satisfactory surgical method in the treatment of lumbosacral arch-string disease,especially for patients with lower extremity sensory-motor disorder.

关 键 词：后柱截骨短缩术 椎弓根螺钉内固定术 椎间融合 腰骶神经弓弦病 马尾综合征 神经根损伤 

分 类 号：R681.553.1[医药卫生—骨科学]