后路腰椎体间融合术后残留神经根症状的分析
|
摘要
[目的]探讨后路腰椎椎体间融合(PLIF)术后残留下肢神经根症状的原因与特点。[方法]纳入22例PLIF术后引流管拔除后出现下肢神经根症状的患者,根据切口超声和CT影像,8例列入有血肿组, 14例列入无血肿组。分析导致残留根性症状的原因,比较两组早期VAS评分和JOA评分。[结果]有血肿组残留根性症状的原因主要是血肿压迫,而无血肿组主要是术中神经根损伤。拔管当日两组患者均为轻度疼痛,VAS、JOA评分差异无统计学意义(P>0.05),而拔管后第1 d,有血肿组表现为疼痛显著加重、功能减退,而无血肿组无明显变化,两组间VAS和JOA评分差异有统计学意义(P<0.05)。此后,两组患者疼痛均渐缓解、功能改善,但有血肿组疼痛缓解和功能改善迅速,而无血肿组改善缓慢。拔管后16 d,有血肿组的VAS评分显著低于无血肿组,而JOA评分高于无血肿组,差异有统计学意义(P<0.05)。[结论]切口内的血肿形成是导致下肢神经根症状的因素之一,但血肿压迫性神经根损伤比其他因素所致的神经根损伤恢复更快,腰椎功能改善也更明显。
[Objective] To explore the causes and characteristics of residual nerve root symptoms after posterior lumbar interbody fusion(PLIF). [Methods] A total of 22 patients who had residual nerve root symptoms after PLIF were included into this study. Based on ultrasound or CT images, 8 patients proved hematoma under the incision, while the 14 patients were of non-hematoma after drainage tubes removed. The reasons of residual nerve root symptoms were searched, additionally the visual analogue scale(VAS) for pain and Japanese Orthopaedic Association(JOA) score for lumbar spine at early stage after operation were compared between the two groups. [Results] The main cause of residual nerve root symptoms in the hematoma group was compression by the hematoma, while that in the non-hematoma group was intraoperative nerve root injuries. At the day of drainage tube removed, the patients in both groups presented mild leg pain and dysfunction without statistically significantly differences in VAS and JOA scores(P>0.05). However, the hematoma group presented significantly pain and function worse at 1 day after drainage tube removed, by contrast, the non-hematoma group kept unchanged, with statistically significantly differences between the two group in VAS and JOA scores(P<0.005). After that, the pain relieved and the function improved in both group,whereas the hematoma group got significantly quick recovery than the non-hematoma groups. At 16 days after drainage tube removed, the hematoma group proved statistically significantly lower VAS score, while higher JOA score than the non-hematoma group(P<0.05). [Conclusion] Hematoma formation in the lumbar wound after removal of the drainage tube is one of the factors leading to residual nerve root symptoms. However, the compression root by hematoma recovers faster, associated with improvement of lumbar function more obvious than other factors leading to nerve root symptoms.
[Objective] To explore the causes and characteristics of residual nerve root symptoms after posterior lumbar interbody fusion(PLIF). [Methods] A total of 22 patients who had residual nerve root symptoms after PLIF were included into this study. Based on ultrasound or CT images, 8 patients proved hematoma under the incision, while the 14 patients were of non-hematoma after drainage tubes removed. The reasons of residual nerve root symptoms were searched, additionally the visual analogue scale(VAS) for pain and Japanese Orthopaedic Association(JOA) score for lumbar spine at early stage after operation were compared between the two groups. [Results] The main cause of residual nerve root symptoms in the hematoma group was compression by the hematoma, while that in the non-hematoma group was intraoperative nerve root injuries. At the day of drainage tube removed, the patients in both groups presented mild leg pain and dysfunction without statistically significantly differences in VAS and JOA scores(P>0.05). However, the hematoma group presented significantly pain and function worse at 1 day after drainage tube removed, by contrast, the non-hematoma group kept unchanged, with statistically significantly differences between the two group in VAS and JOA scores(P<0.005). After that, the pain relieved and the function improved in both group,whereas the hematoma group got significantly quick recovery than the non-hematoma groups. At 16 days after drainage tube removed, the hematoma group proved statistically significantly lower VAS score, while higher JOA score than the non-hematoma group(P<0.05). [Conclusion] Hematoma formation in the lumbar wound after removal of the drainage tube is one of the factors leading to residual nerve root symptoms. However, the compression root by hematoma recovers faster, associated with improvement of lumbar function more obvious than other factors leading to nerve root symptoms.
引文
[1] Trigg SD, Devilbiss Z. Spine conditions:lumbar spinal stenosis[J].FP Essent, 2017, 461(1):21-25.
[2] Yamada K, Aota Y, Higashi T, et al. Lumbar foraminal stenosis causes leg pain at rest[J]. Eur Spine, 2014, 23(3):504-507.
[3] Huskisson EC. Measurement of pain[J]. Lancet, 1974, 2(7889):1127-1131.
[4] Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 2.Verification of its reliability:the subcommittee on low back pain and cervical myelopathy evaluation of the clinical outcome committee of the japanese orthopaedic association[J]. Orthop Sci, 2007, 12(6):526-532.
[5] Jones TL, Hisey MS. L5radiculopathy caused by L5nerve root entrapment by an L5-S1anterior osteophyte[J]. Int J Spine Surg2012, 6(1):174-177.
[6] Yamamoto K, Gondo G, Ogino H, et al. Sciatic neuralgia caused by May-thurner syndrome, case report[J].World Neurosurg, 2018, 8:40-43.
[7] Yu C, Zhengqi C, Xiuchun Y. An Amendment to the neidre and macnab classification system for lumbosacral nerve root anomaly and its implication in percutaneous endoscopic lumbar discectomy[J]. World Neurosurg, 2018, 111(1):16-21.
[8] Li SW, Yin HP, Wu YM, et al. Analysis of intraoperative complications of microendoscopic disectomy and corresponding preventive measures[J]. Zhongguo Gu Shang, 2013, 26(3):218-219.
[9] Stienen MN, Joswig H, Chau I, et al. Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy:a matched-control study[J]. Neurosurg Spine, 2018, 28(3):291-299.
[10] Li T, Shi L, Luo Y, et al. One-level or multilevel interbody fusion for multilevel lumbar degenerative diseases:a prospective randomized control study with a 4-year follow-up[J].World Neurosurge,2018, 110:815-822.
[11] Hu HT, Ren L, Sun XZ, et al. Contralateral radiculopathy after transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases:a case series[J]. Medicine(Baltimore)2018, 97(16):469.
[2] Yamada K, Aota Y, Higashi T, et al. Lumbar foraminal stenosis causes leg pain at rest[J]. Eur Spine, 2014, 23(3):504-507.
[3] Huskisson EC. Measurement of pain[J]. Lancet, 1974, 2(7889):1127-1131.
[4] Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 2.Verification of its reliability:the subcommittee on low back pain and cervical myelopathy evaluation of the clinical outcome committee of the japanese orthopaedic association[J]. Orthop Sci, 2007, 12(6):526-532.
[5] Jones TL, Hisey MS. L5radiculopathy caused by L5nerve root entrapment by an L5-S1anterior osteophyte[J]. Int J Spine Surg2012, 6(1):174-177.
[6] Yamamoto K, Gondo G, Ogino H, et al. Sciatic neuralgia caused by May-thurner syndrome, case report[J].World Neurosurg, 2018, 8:40-43.
[7] Yu C, Zhengqi C, Xiuchun Y. An Amendment to the neidre and macnab classification system for lumbosacral nerve root anomaly and its implication in percutaneous endoscopic lumbar discectomy[J]. World Neurosurg, 2018, 111(1):16-21.
[8] Li SW, Yin HP, Wu YM, et al. Analysis of intraoperative complications of microendoscopic disectomy and corresponding preventive measures[J]. Zhongguo Gu Shang, 2013, 26(3):218-219.
[9] Stienen MN, Joswig H, Chau I, et al. Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy:a matched-control study[J]. Neurosurg Spine, 2018, 28(3):291-299.
[10] Li T, Shi L, Luo Y, et al. One-level or multilevel interbody fusion for multilevel lumbar degenerative diseases:a prospective randomized control study with a 4-year follow-up[J].World Neurosurge,2018, 110:815-822.
[11] Hu HT, Ren L, Sun XZ, et al. Contralateral radiculopathy after transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases:a case series[J]. Medicine(Baltimore)2018, 97(16):469.