TILF術(shù)后對側(cè)神經(jīng)癥狀的原因分析
發(fā)布時間：2018-09-12 05:53
【摘要】：目的:隨著經(jīng)椎間孔椎體間融合(Transforaminal lumbar interbody fusion)術(shù)(TLIF)在脊柱退行性疾病的治療中的廣泛應(yīng)用,術(shù)后對側(cè)神經(jīng)癥狀作為一種潛在并發(fā)癥還不為人們所認(rèn)知和重視,但此并發(fā)癥的發(fā)生卻直接影響TLIF術(shù)后的療效及康復(fù)。本研究旨在統(tǒng)計TLIF術(shù)后患者對側(cè)神經(jīng)癥狀的發(fā)生率,觀察其治療轉(zhuǎn)歸并探討其發(fā)生的可能原因。方法:對我院自2009年1月至2012年12月所行的476例資料完整的TILF手術(shù)病例及術(shù)后隨訪資料進(jìn)行回顧性分析。其中行單節(jié)段TLIF手術(shù)359例,雙節(jié)段117例。包括男性291例,女性185例,年齡19-68歲,平均55.3歲。根據(jù)術(shù)后是否出現(xiàn)對側(cè)神經(jīng)癥狀將其分為癥狀組(S組)與非癥狀組(N組)。從N組患者中隨機(jī)抽取40例,包括男性22例,女性18例,與S組患者一起術(shù)后隨訪6-28個月,平均14.3個月。分別于術(shù)前和術(shù)后即刻或隨訪時行腰椎正側(cè)位X線片及手術(shù)節(jié)段椎間孔CT平掃,以測量其手術(shù)前后對側(cè)椎間孔面積差和椎間高度指數(shù)(disc-height index;DHI)差并進(jìn)行組間對比。另外根據(jù)是否行二次手術(shù)治療將癥狀組分為一過性神經(jīng)癥狀組(T組)和手術(shù)探查組(O組),對癥狀出現(xiàn)時間、癥狀持續(xù)時間、對脫水藥物治療的反應(yīng)、癥狀的嚴(yán)重程度(VAS、JOA評分)進(jìn)行統(tǒng)計學(xué)分析,對O組患者二次術(shù)后隨訪1年統(tǒng)計其探查術(shù)后癥狀改善率。結(jié)果:入組本項(xiàng)研究的476例TLIF手術(shù)中術(shù)后出現(xiàn)對側(cè)神經(jīng)癥狀者共18例,其中男性11例,女性7例,總患病率為3.7815%。S組與N組相比手術(shù)前后對側(cè)椎間孔面積差(S組+1.7mm2±10.1,N組+5.8mm2±4.5),手術(shù)節(jié)段椎間高度指數(shù)差(S組0.01±0.16;N組0.18±0.23)相比有統(tǒng)計學(xué)意義(P0.05=。S組中因保守治療無效行手術(shù)探查者共5例(O組),其中男性3例,女性2例,手術(shù)探查率為1.0504%。剩余13例為一過性神經(jīng)癥狀(T組),其中男性8例,女性5例。T組與O組在癥狀出現(xiàn)時間(T組均值術(shù)后86.7h;O組均值術(shù)后28h)、癥狀持續(xù)時間(T組均值57.4h;O組均值270.6h)、對脫水藥物治療的反應(yīng)(T組有效率88.9%;O組有效率0%)、癥狀的嚴(yán)重程度(T組JOA均值24.78,VAS均值2.85;O組JOA均值13.4,VAS均值6.6)等指標(biāo)的差異均具有統(tǒng)計學(xué)意義(P0.05=,對O組患者的探查術(shù)后1年回訪顯示探查術(shù)后癥狀(JOA評分)改善率為95.42%。結(jié)論:TLIF手術(shù)后對側(cè)神經(jīng)癥狀是TLIF手術(shù)的一種潛在并發(fā)癥,其發(fā)病原因可能與術(shù)后椎間隙高度恢復(fù)不足、對側(cè)椎間孔形態(tài)的改變、術(shù)后神經(jīng)水腫反應(yīng)、植骨塊移位及置釘位置不良等多種因素有關(guān)。對有明確神經(jīng)損害的對側(cè)神經(jīng)癥狀患者,應(yīng)早期行二次手術(shù)探查治療以提高患者預(yù)后。
[Abstract]:Objective: with the wide application of transforaminal interbody fusion (Transforaminal lumbar interbody fusion) in the treatment of spinal degenerative diseases, the contralateral nerve symptoms as a potential complication have not been recognized and paid attention to. However, the occurrence of this complication directly affects the curative effect and rehabilitation after TLIF. The purpose of this study was to investigate the incidence of contralateral neurological symptoms after TLIF, to observe the outcome of treatment and to explore the possible causes. Methods: the data of 476 cases of TILF operation from January 2009 to December 2012 were retrospectively analyzed. There were 359 cases of single segment TLIF operation and 117 cases of double segment operation. This included 291 males and 185 females aged 19-68 with an average of 55.3 years. The patients were divided into symptomatic group (S group) and non-symptomatic group (N group) according to whether the contralateral nerve symptoms appeared after operation. Forty patients in group N were randomly selected, including 22 males and 18 females. The patients in group S were followed up for 6-28 months, with an average of 14.3 months. CT plain scan of anterior and lateral lumbar vertebrae and segmental intervertebral foramen were performed before and after operation, respectively. The area difference of contralateral intervertebral foramina and the difference of intervertebral height index (disc-height index;DHI) before and after operation were measured and compared between the two groups. In addition, the symptom groups were divided into temporary neurological symptoms group (T group) and surgical exploration group (O group) according to whether the second operation was performed. The symptoms appeared time, symptom duration, and reaction to dehydration drug therapy. The severity of symptoms (VAS,JOA score) was statistically analyzed. Results: there were 18 patients with contralateral nerve symptoms in 476 cases of TLIF, including 11 males and 7 females. The total prevalence rate was 3.7815.S group compared with N group in the area difference of contralateral intervertebral foramina (1.7mm2 鹵10.1N group 5.8mm2 鹵4.5in S group), and the difference of intervertebral height index (S group 0.01 鹵0.16N group 0.18 鹵0.23) was statistically significant (P0.05.S group because conservative treatment was not effective in surgical exploration). There were 5 cases (group O), of which 3 cases were males. In 2 cases of female, the rate of surgical exploration was 1.0504%. The remaining 13 cases were transient neurological symptoms (group T), including 8 males, 5 female patients. Group T and group O had symptoms (mean 86.7 hours after operation 28 hours after operation), duration of symptoms (mean of 57.4 hours in group T, 270.6 hours), response to dehydration drug therapy (effective rate of 88.9% in group T was 88.9%) and severity of symptoms. There were significant differences in the degree of JOA (JOA mean 13.4VAS mean 6.6) in group T (24.78 JOA mean 2.85min) (P0.05%). The improvement rate of JOA score in group O was 95.42%. Conclusion the contralateral nerve symptom is a potential complication of TLIF operation, which may be due to the insufficient recovery of intervertebral space, the change of the morphology of contralateral intervertebral foramen, and the reaction of nerve edema after operation. There are many factors related to the displacement of bone graft and the poor position of nail insertion. In order to improve the prognosis of patients with contralateral nerve symptoms with definite nerve damage, secondary surgical exploration should be performed early.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：2238103
[Abstract]:Objective: with the wide application of transforaminal interbody fusion (Transforaminal lumbar interbody fusion) in the treatment of spinal degenerative diseases, the contralateral nerve symptoms as a potential complication have not been recognized and paid attention to. However, the occurrence of this complication directly affects the curative effect and rehabilitation after TLIF. The purpose of this study was to investigate the incidence of contralateral neurological symptoms after TLIF, to observe the outcome of treatment and to explore the possible causes. Methods: the data of 476 cases of TILF operation from January 2009 to December 2012 were retrospectively analyzed. There were 359 cases of single segment TLIF operation and 117 cases of double segment operation. This included 291 males and 185 females aged 19-68 with an average of 55.3 years. The patients were divided into symptomatic group (S group) and non-symptomatic group (N group) according to whether the contralateral nerve symptoms appeared after operation. Forty patients in group N were randomly selected, including 22 males and 18 females. The patients in group S were followed up for 6-28 months, with an average of 14.3 months. CT plain scan of anterior and lateral lumbar vertebrae and segmental intervertebral foramen were performed before and after operation, respectively. The area difference of contralateral intervertebral foramina and the difference of intervertebral height index (disc-height index;DHI) before and after operation were measured and compared between the two groups. In addition, the symptom groups were divided into temporary neurological symptoms group (T group) and surgical exploration group (O group) according to whether the second operation was performed. The symptoms appeared time, symptom duration, and reaction to dehydration drug therapy. The severity of symptoms (VAS,JOA score) was statistically analyzed. Results: there were 18 patients with contralateral nerve symptoms in 476 cases of TLIF, including 11 males and 7 females. The total prevalence rate was 3.7815.S group compared with N group in the area difference of contralateral intervertebral foramina (1.7mm2 鹵10.1N group 5.8mm2 鹵4.5in S group), and the difference of intervertebral height index (S group 0.01 鹵0.16N group 0.18 鹵0.23) was statistically significant (P0.05.S group because conservative treatment was not effective in surgical exploration). There were 5 cases (group O), of which 3 cases were males. In 2 cases of female, the rate of surgical exploration was 1.0504%. The remaining 13 cases were transient neurological symptoms (group T), including 8 males, 5 female patients. Group T and group O had symptoms (mean 86.7 hours after operation 28 hours after operation), duration of symptoms (mean of 57.4 hours in group T, 270.6 hours), response to dehydration drug therapy (effective rate of 88.9% in group T was 88.9%) and severity of symptoms. There were significant differences in the degree of JOA (JOA mean 13.4VAS mean 6.6) in group T (24.78 JOA mean 2.85min) (P0.05%). The improvement rate of JOA score in group O was 95.42%. Conclusion the contralateral nerve symptom is a potential complication of TLIF operation, which may be due to the insufficient recovery of intervertebral space, the change of the morphology of contralateral intervertebral foramen, and the reaction of nerve edema after operation. There are many factors related to the displacement of bone graft and the poor position of nail insertion. In order to improve the prognosis of patients with contralateral nerve symptoms with definite nerve damage, secondary surgical exploration should be performed early.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前8條
1 王鵬;金格勒;楊毅;;腰椎椎弓根螺釘內(nèi)固定中計算機(jī)輔助導(dǎo)航應(yīng)用的Meta分析[J];中國組織工程研究;2014年09期
2 羅志強(qiáng);張玉;繆滋光;;磷酸鈣骨水泥強(qiáng)化骨質(zhì)疏松綿羊腰椎力學(xué)強(qiáng)度的動態(tài)觀察[J];實(shí)用骨科雜志;2011年05期
3 王建華;王善琛;陳立業(yè);夏虹;尹慶水;;幾種微創(chuàng)椎間融合術(shù)內(nèi)固定術(shù)式的生物力學(xué)比較[J];脊柱外科雜志;2011年01期
4 卓祥龍;胡建中;李兵;孫宏志;陳耀輝;胡朝輝;;三種術(shù)式治療復(fù)發(fā)性腰椎間盤突出癥比較研究[J];中國修復(fù)重建外科雜志;2009年12期
5 陳博來;林定坤;孔暢;郭玉海;王羽豐;寧飛鵬;;腰椎后路微創(chuàng)TLIF和開放PLIF兩種術(shù)式臨床短期效果報告[J];脊柱外科雜志;2009年04期
6 曹恒聰;李永民;張洪斌;王旭;;兩種椎間融合器植入方式治療腰椎退行性疾病的療效對比分析[J];中國綜合臨床;2007年10期
7 趙慧毅;陳輝東;華強(qiáng);陳國能;林勁松;;PLIF與TLIF治療腰椎不穩(wěn)癥的療效比較[J];脊柱外科雜志;2006年06期
8 蔣西嘉;徐南偉;周棟;;后路和經(jīng)椎間孔入路腰椎椎體間融合術(shù)治療退變性腰椎滑脫的臨床療效[J];中國醫(yī)師進(jìn)修雜志;2010年35期
，本文編號：2238103
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