经皮脊柱内镜技术治疗椎间盘源性马尾综合征5例疗效观察
|
摘要
目的探讨经皮脊柱内镜技术治疗椎间盘源性马尾综合征的临床效果。方法回顾性分析2014年10月～2016年12月采用脊柱内镜技术治疗5例椎间盘源性马尾综合征的临床资料。其中椎间盘突出位于L_5/S_1 3例,L_(4/5)、L_(2/3)各1例。5例均在脊柱内镜下摘除突出椎间盘,行根管及椎管减压。结果 5例均完成手术,未发生神经根损伤、硬膜囊撕裂、椎间隙感染等并发症。5例于术后即刻下肢疼痛均缓解,视觉模拟评分(Visual Analogue Scale,VAS)由术前(7.8±0.7)分降为(2.8±0.7)分。术后第3天复查MRI提示椎管及根管无明显受压。1例术后第5天椎间盘突出复发行二次内镜手术。5例随访6～24个月,平均12.4月。末次随访日本骨科学会(Japanese Orthpaedic Association,JOA)下腰痛评分为23.6±2.4,优4例,良1例。术后3个月下肢肌力2例由术前Ⅲ级恢复至Ⅳ级,3例由术前Ⅳ级恢复至Ⅴ级。鞍区及会阴部感觉2例于术后6个月、2例12个月恢复正常,1例术后15个月部分恢复,仍残留部分感觉异常。直肠膀胱功能方面:3例小便费力不尽感者于术后5～7个月恢复正常,1例尿潴留者术后1年仍需间断导尿,有大便不尽感且偶发肠胀气。结论脊柱内镜技术是治疗椎间盘源性马尾综合征的安全、有效的微创手术方法。
Objective To explore the clinical effects of percutaneous endoscopic lumbar discectomy( PELD) for cauda equina syndrome( CES) caused by lumbar disc herniation( LDH). Methods A total of 5 patients with CES caused by LDH who underwent PELD from October 2014 to December 2016 were selected as the objects of study. The number of patients with LDH segment of L_5/S_1,L_(4/5),and L_(2/3) was 3,1,and 1,respectively. For the 5 patients,their root canal and spinal canal were decompressed with PELD. Results There were no complications of nerve root injury,dura mater laceration or intervertebral space infection. For the 5 patients,the pain of the lower limbs was relieved immediately after operation. The Visual Analogue Scale( VAS) scores decreased from( 7. 8 ± 0. 7) points to( 2. 8 ± 0. 7) points. The MRI at 3 days after operation did not show any obvious compression on dura mater and nerve root. The second surgery was performed on a patient with recurrent disc herniation at 5 days after operation. All the patients were followed up for 6-24 months,with an average of 12. 4 months. The Japanese Orthpaedic Association( JOA) scores of low back pain were increased from( 6. 2 ± 0. 7) points at pre-operation to( 23. 6 ± 2. 4) points at the last follow-up post-operation,showing 4 cases of excellent results and 1 case of good result. The muscle strength of the lower limbs was obviously restored at 3 months after operation. Among them,the muscle strength of 2 patients was improved from grade Ⅲ to Ⅳ and that of 3 patients was improved from grade Ⅳ to Ⅴ. In aspect of the feeling of saddle area and perineum,2 patients returned to normal at 6 months after operation,and 2 patients returned to normal at 12 months after operation. However,1 patient was back to normal partly at 15 months after operation. In terms of the urinary and bowel functions,3 patients with urinary insufficiency became normal at 5-7 months after operation. One patient with urinary retention needed intermittent catheterization,and incomplete defecation and occasional flatulence occurred at 1 year after operation. Conclusion PELD is a safe and effective minimally invasive surgical technique for the treatment of CES caused by disc herniation.
Objective To explore the clinical effects of percutaneous endoscopic lumbar discectomy( PELD) for cauda equina syndrome( CES) caused by lumbar disc herniation( LDH). Methods A total of 5 patients with CES caused by LDH who underwent PELD from October 2014 to December 2016 were selected as the objects of study. The number of patients with LDH segment of L_5/S_1,L_(4/5),and L_(2/3) was 3,1,and 1,respectively. For the 5 patients,their root canal and spinal canal were decompressed with PELD. Results There were no complications of nerve root injury,dura mater laceration or intervertebral space infection. For the 5 patients,the pain of the lower limbs was relieved immediately after operation. The Visual Analogue Scale( VAS) scores decreased from( 7. 8 ± 0. 7) points to( 2. 8 ± 0. 7) points. The MRI at 3 days after operation did not show any obvious compression on dura mater and nerve root. The second surgery was performed on a patient with recurrent disc herniation at 5 days after operation. All the patients were followed up for 6-24 months,with an average of 12. 4 months. The Japanese Orthpaedic Association( JOA) scores of low back pain were increased from( 6. 2 ± 0. 7) points at pre-operation to( 23. 6 ± 2. 4) points at the last follow-up post-operation,showing 4 cases of excellent results and 1 case of good result. The muscle strength of the lower limbs was obviously restored at 3 months after operation. Among them,the muscle strength of 2 patients was improved from grade Ⅲ to Ⅳ and that of 3 patients was improved from grade Ⅳ to Ⅴ. In aspect of the feeling of saddle area and perineum,2 patients returned to normal at 6 months after operation,and 2 patients returned to normal at 12 months after operation. However,1 patient was back to normal partly at 15 months after operation. In terms of the urinary and bowel functions,3 patients with urinary insufficiency became normal at 5-7 months after operation. One patient with urinary retention needed intermittent catheterization,and incomplete defecation and occasional flatulence occurred at 1 year after operation. Conclusion PELD is a safe and effective minimally invasive surgical technique for the treatment of CES caused by disc herniation.
引文
1刘万军,崔学文,马进峰.马尾综合征影响治疗效果因素的研究.中国矫形外科杂志,2001,8(2):115-117.
2 贾连顺.重视急性马尾神经综合征的早期诊断与治疗.中华外科杂志,2008,46(21):1665-1666.
3 曹其亮,汤健.影响腰椎间盘突出症伴马尾综合征手术治疗预后的相关因素.颈腰痛杂志,2011,32(6):466-467.
4 Pfirrmann CW,Metzdorf A,Zanetti M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine,2001,26(17):1873-1878.
5 赵伟,李长青,周跃,等.经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症.中国矫形外科杂志,2012,20(13):1191-1195.
6 官正茂,孙学军,史建刚,等.腹腔注射氢生理盐水对急性马尾综合征大鼠神经功能的影响及相关机制初探.中国脊柱脊髓杂志,2013,23(6):537-545.
7 Korse N,Jacobs W,Elzevier H,et al.Complaints of micturition,defecation and sexual function in cauda equina syndrome due to lumbar disk herniation:a systematic review.Eur Spine J,2013,22(5):1019-1029.
8 Jalloh I,Minhas P.Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department.Emerg Med J,2007,24(1):33-34.
9 Tamburrelli F,Genitiempo M,Bochicchio M,et al.Cauda equina syndrome:evaluation of the clinical outcome.Eur Rev Med Pharmacol Sci,2014,18(7):1098-1105.
10 林建春,黄剑虹,林永珍.腰椎间盘突出症致马尾神经综合征的手术治疗.临床骨科杂志,2013,16(6):627-629.
11 Kim JS,Seong JH.Endoscope-assisted oblique lumbar interbody fusion for the treatment of cauda equina syndrome:a technical note.Eur Spine J,2017,26(2):397-403.
12 Shih P,Smith TR,Fessler RG,et al.Minimally invasive discectomy for the treatment of disc herniation causing cauda equina syndrome.J Clin Neurosci,2011,18(9):1219-1223.
13 李志琳,施多伟,窦强,等.椎间盘镜下神经根管减压术治疗根性症状为主的腰椎退行性病变.中国微创外科杂志,2013,13(7):621-624.
14 周跃,李长青,王健,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症.中华骨科杂志,2010,30(3):225-231.
15 李广松,乔荣慧,刘伟,等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄.中国微创外科杂志,2015,15(6):522-526.
16 Li X,Dou Q,Hu S,et al.Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy.Acta Neurol Belg,2016,116(2):185-190.
17 Grammaticos P,Papadopoulos N,Tarazi L,et al.Cauda equina syndrome.An emergency,some unexpected severe symptoms and conservative treatment.Hell J Nucl Med,2016,19(3):277-280.
18 Kim JH,Hong JC,Kim MS,et al.Sacral nerve stimulation for treatment of intractable pain associated with cauda equina syndrome.J Korean Neurosurg Soc,2010,47(6):473-476.
2 贾连顺.重视急性马尾神经综合征的早期诊断与治疗.中华外科杂志,2008,46(21):1665-1666.
3 曹其亮,汤健.影响腰椎间盘突出症伴马尾综合征手术治疗预后的相关因素.颈腰痛杂志,2011,32(6):466-467.
4 Pfirrmann CW,Metzdorf A,Zanetti M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine,2001,26(17):1873-1878.
5 赵伟,李长青,周跃,等.经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症.中国矫形外科杂志,2012,20(13):1191-1195.
6 官正茂,孙学军,史建刚,等.腹腔注射氢生理盐水对急性马尾综合征大鼠神经功能的影响及相关机制初探.中国脊柱脊髓杂志,2013,23(6):537-545.
7 Korse N,Jacobs W,Elzevier H,et al.Complaints of micturition,defecation and sexual function in cauda equina syndrome due to lumbar disk herniation:a systematic review.Eur Spine J,2013,22(5):1019-1029.
8 Jalloh I,Minhas P.Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department.Emerg Med J,2007,24(1):33-34.
9 Tamburrelli F,Genitiempo M,Bochicchio M,et al.Cauda equina syndrome:evaluation of the clinical outcome.Eur Rev Med Pharmacol Sci,2014,18(7):1098-1105.
10 林建春,黄剑虹,林永珍.腰椎间盘突出症致马尾神经综合征的手术治疗.临床骨科杂志,2013,16(6):627-629.
11 Kim JS,Seong JH.Endoscope-assisted oblique lumbar interbody fusion for the treatment of cauda equina syndrome:a technical note.Eur Spine J,2017,26(2):397-403.
12 Shih P,Smith TR,Fessler RG,et al.Minimally invasive discectomy for the treatment of disc herniation causing cauda equina syndrome.J Clin Neurosci,2011,18(9):1219-1223.
13 李志琳,施多伟,窦强,等.椎间盘镜下神经根管减压术治疗根性症状为主的腰椎退行性病变.中国微创外科杂志,2013,13(7):621-624.
14 周跃,李长青,王健,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症.中华骨科杂志,2010,30(3):225-231.
15 李广松,乔荣慧,刘伟,等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄.中国微创外科杂志,2015,15(6):522-526.
16 Li X,Dou Q,Hu S,et al.Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy.Acta Neurol Belg,2016,116(2):185-190.
17 Grammaticos P,Papadopoulos N,Tarazi L,et al.Cauda equina syndrome.An emergency,some unexpected severe symptoms and conservative treatment.Hell J Nucl Med,2016,19(3):277-280.
18 Kim JH,Hong JC,Kim MS,et al.Sacral nerve stimulation for treatment of intractable pain associated with cauda equina syndrome.J Korean Neurosurg Soc,2010,47(6):473-476.