显微手术治疗骶管囊肿43例临床分析

发布时间：2018-10-10 06:39

【摘要】：目的探讨骶管囊肿的手术方式及疗效。方法 2015年1月~2017年1月,显微外科治疗骶管囊肿43例,后正中切口行椎板切除或椎板切开保留回置,显微镜下行囊肿漏口修补、神经根松解、神经根袖状成形缝合或漏口缝扎、切断外终丝,小囊肿在神经电生理监测下电凝塑形,明胶海绵、止血纱与人工硬脊膜材料或椎旁肌肌肉瓣填充骶管内残腔。结果行神经根袖状成形25例,其中合并小囊肿予以囊壁电凝塑形2例;囊肿漏口缝扎17例,其中9例行外终丝切断;臀大肌肌皮瓣填充1例。椎板切除28例,椎板回置15例。手术时间82~300 min,中位数161 min,术中出血10~300 ml,中位数50 ml。随访6~27个月,中位时间15个月。与术前相比,末次随访时疼痛视觉模拟评分(VAS)显著降低[中位数6分(0~10分)vs.0分(0~8分),Z=-5.230,P=0.000],JOA评分显著升高[21分(4~28分)vs.28分(20~29分),Z=-5.314,P=0.000]。治愈19例(44.2%),显效12例(27.9%),有效4例(9.3%),无效8例(18.6%),总有效率81.4%(35/43)。结论依据囊肿类型采取分类显微外科手术治疗骶管囊肿微创、安全,能够明显改善疼痛症状及神经功能,囊肿漏口的处理和神经根松解是治疗的关键,应早期治疗以恢复骶管正常解剖学形态。
[Abstract]:Objective to investigate the operative method and curative effect of sacral cyst. Methods from January 2015 to January 2017, 43 cases of sacral canal cyst were treated by microsurgery. Laminectomy or laminectomy were performed in the posterior median incision, the leakage of cyst was repaired under microscope, and the nerve root was loosened. Nerve root cuff shaped suture or leakage suture, transection of outer end filaments, electrocoagulation of small cysts, gelatin sponge, hemostatic gauze and artificial dura mater or paravertebral muscle flap to fill sacral canal residual cavity. Results nerve root cuff formation was performed in 25 cases, of which 2 cases were complicated with small cyst, 17 cases were suture of cyst leakage, 9 cases were transection of outer end filaments, 1 case was filled with gluteus maximus myocutaneous flap. Laminectomy was performed in 28 cases and laminectomy in 15 cases. Operative time 82 min, median 161 min, intraoperative bleeding 10 ml, median 50 ml. The follow-up period was 6 to 27 months, with a median time of 15 months. Compared with before operation, the (VAS) score of pain visual analogue score decreased significantly [median 6 points (0 ~ 10) vs.0 score (0 ~ 8 points)] JOA score increased significantly [21 (4 ~ 28) vs.28 score (20 ~ 29) scores) and 5. 314P 0. 000] at the last follow-up, the pain visual analogue score (VAS) was significantly lower than that before operation [median 6 points (0 ~ 10) vs.0 scores (0 ~ 8 points)] and significantly increased [21 (4 ~ 28) vs.28 scores (20 ~ 29) scores]. 19 cases (44.2%) were cured, 12 cases (27.9%) were effective, 4 cases (9.3%) were effective, 8 cases (18.6%) were ineffective, the total effective rate was 81.4% (35 / 43). Conclusion it is safe and safe to treat sacral canal cyst by classified microsurgery according to the type of cyst. The treatment of cyst leakage and nerve root release is the key to the treatment. Early treatment should be used to restore the normal anatomy of the sacral canal.
【作者单位】：北京大学第三医院神经外科;
【基金】：北京大学第三医院2014年院重点项目基金(bysy201304)
【分类号】：R651.2

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