TILF术后对侧神经症状的原因分析
发布时间：2018-09-12 05:53
【摘要】：目的:随着经椎间孔椎体间融合(Transforaminal lumbar interbody fusion)术(TLIF)在脊柱退行性疾病的治疗中的广泛应用,术后对侧神经症状作为一种潜在并发症还不为人们所认知和重视,但此并发症的发生却直接影响TLIF术后的疗效及康复。本研究旨在统计TLIF术后患者对侧神经症状的发生率,观察其治疗转归并探讨其发生的可能原因。方法:对我院自2009年1月至2012年12月所行的476例资料完整的TILF手术病例及术后随访资料进行回顾性分析。其中行单节段TLIF手术359例,双节段117例。包括男性291例,女性185例,年龄19-68岁,平均55.3岁。根据术后是否出现对侧神经症状将其分为症状组(S组)与非症状组(N组)。从N组患者中随机抽取40例,包括男性22例,女性18例,与S组患者一起术后随访6-28个月,平均14.3个月。分别于术前和术后即刻或随访时行腰椎正侧位X线片及手术节段椎间孔CT平扫,以测量其手术前后对侧椎间孔面积差和椎间高度指数(disc-height index;DHI)差并进行组间对比。另外根据是否行二次手术治疗将症状组分为一过性神经症状组(T组)和手术探查组(O组),对症状出现时间、症状持续时间、对脱水药物治疗的反应、症状的严重程度(VAS、JOA评分)进行统计学分析,对O组患者二次术后随访1年统计其探查术后症状改善率。结果:入组本项研究的476例TLIF手术中术后出现对侧神经症状者共18例,其中男性11例,女性7例,总患病率为3.7815%。S组与N组相比手术前后对侧椎间孔面积差(S组+1.7mm2±10.1,N组+5.8mm2±4.5),手术节段椎间高度指数差(S组0.01±0.16;N组0.18±0.23)相比有统计学意义(P0.05=。S组中因保守治疗无效行手术探查者共5例(O组),其中男性3例,女性2例,手术探查率为1.0504%。剩余13例为一过性神经症状(T组),其中男性8例,女性5例。T组与O组在症状出现时间(T组均值术后86.7h;O组均值术后28h)、症状持续时间(T组均值57.4h;O组均值270.6h)、对脱水药物治疗的反应(T组有效率88.9%;O组有效率0%)、症状的严重程度(T组JOA均值24.78,VAS均值2.85;O组JOA均值13.4,VAS均值6.6)等指标的差异均具有统计学意义(P0.05=,对O组患者的探查术后1年回访显示探查术后症状(JOA评分)改善率为95.42%。结论:TLIF手术后对侧神经症状是TLIF手术的一种潜在并发症,其发病原因可能与术后椎间隙高度恢复不足、对侧椎间孔形态的改变、术后神经水肿反应、植骨块移位及置钉位置不良等多种因素有关。对有明确神经损害的对侧神经症状患者,应早期行二次手术探查治疗以提高患者预后。
[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 卤10.1N group 5.8mm2 卤4.5in S group), and the difference of intervertebral height index (S group 0.01 卤0.16N group 0.18 卤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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：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 卤10.1N group 5.8mm2 卤4.5in S group), and the difference of intervertebral height index (S group 0.01 卤0.16N group 0.18 卤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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前8条
1 王鹏;金格勒;杨毅;;腰椎椎弓根螺钉内固定中计算机辅助导航应用的Meta分析[J];中国组织工程研究;2014年09期
2 罗志强;张玉;缪滋光;;磷酸钙骨水泥强化骨质疏松绵羊腰椎力学强度的动态观察[J];实用骨科杂志;2011年05期
3 王建华;王善琛;陈立业;夏虹;尹庆水;;几种微创椎间融合术内固定术式的生物力学比较[J];脊柱外科杂志;2011年01期
4 卓祥龙;胡建中;李兵;孙宏志;陈耀辉;胡朝辉;;三种术式治疗复发性腰椎间盘突出症比较研究[J];中国修复重建外科杂志;2009年12期
5 陈博来;林定坤;孔畅;郭玉海;王羽丰;宁飞鹏;;腰椎后路微创TLIF和开放PLIF两种术式临床短期效果报告[J];脊柱外科杂志;2009年04期
6 曹恒聪;李永民;张洪斌;王旭;;两种椎间融合器植入方式治疗腰椎退行性疾病的疗效对比分析[J];中国综合临床;2007年10期
7 赵慧毅;陈辉东;华强;陈国能;林劲松;;PLIF与TLIF治疗腰椎不稳症的疗效比较[J];脊柱外科杂志;2006年06期
8 蒋西嘉;徐南伟;周栋;;后路和经椎间孔入路腰椎椎体间融合术治疗退变性腰椎滑脱的临床疗效[J];中国医师进修杂志;2010年35期
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