直视下选择性神经根管减压术治疗腰骶神经根病的疗效评价

目的 探讨直视下选择性神经根管减压术治疗腰骶神经根病的临床疗效.方法 回顾性分析2002年3月至2008年11月应用直视下选择性神经根管减压术治疗且随访超过3年的178例腰骶神经根病患者资料,男95例,女83例；年龄22～73岁,平均48.2岁.狭窄部位:L2,34例,L3,4 17例,L4,5 49例,L5S1 55例,双节段37例,三节段及以上病变16例.依据神经根走行及神经根管解剖特点,结合Lee等对神经根管的入口区、中间区及出口区三分区理论,对神经根的受压部位行直视下选择性神经根管减压术.术后以Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉模拟评分(visual analogue scale,VAS)及Macnab标准评定功能.结果 手术时间30～60 min,平均(45±10) min；术中出血量10～150 ml,平均(50±20) ml.术前、术后2周、6、12、36个月ODI分别为62.33％±8.70％、26.40％±10.30％、23.80％±10.30％、27.10％±9.90％、33.00％±8.90％,VAS分别为(7.20±1.23)分、(1.56±1.17)分、(1.19±1.43)分、(1.16±1.32)分、(1.26±1.17)分.Macnab评价优良率,术后2周为91.0％(162/178),术后6个月为88.2％(157/178),术后12个月为84.8％(151/178),术后36个月为83.7％ (149/178).结论 直视下选择性神经根管减压术治疗腰骶神经根病手术时间短、术中出血少,术后症状改善明显.

Selective decompression of nerve root canal under direct vision for lumbosacral radiculopathy

Objective To evaluate the clinical effect of selective decompression of nerve root canal under direct vision for lumbosacral radiculopathy. Methods Data of 178 patients who had undergone selective decompression of nerve root canal under direct vision for lumbosacral radiculopathy from March 2002 to November 2008 were retrospectively analyzed, including 95 males and 83 females, aged from 22 to 73 years (average, 48.2 years). All patients were followed up for more than 3 years. Stenosis site was at L2, 3 in 4 cases, L3, 4 in 17, L4, 5 in 49, L5S1 in 55 and multi-level in 53. Based on the anatomical characteristics of nerve roots and nerve root canal, as well as Lee's stenosis zone classification (entrance zone stenosis, mid-zone stenosis and exit zone stenosis), the selective decompression of lumbar root canal was performed in all patients under direct vision. Oswestry disability index (ODI), visual analogue scale (VAS) and the Macnab criteria were used to assess the clinical effect postoperatively. Results The mean operation time was 45±10 min (range, 30-60 min), and the mean intraoperative blood loss was 50±20 ml (range, 10-150 ml). The average ODI was 62.33%±8.70%, 26.40%±10.30%, 23.8%±10.30%, 27.10%±9.90% and 33.00%±8.90% before operation and at 2 weeks, 6 months, 12 months and 36 months after operation, respectively; for VAS, it was 7.20±1.23, 1.56±1.17, 1.19±1.43, 1.16±1.32 and 1.26±1.17. According to the Macnab criteria, the overall excellent and good rate was 91.0% (162/178), 88.2% (157/178), 84.8% (151/178) and 83.7% (149/178) at 2 weeks, 6 months, 12 months and 36 months after operation, respectively. Conclusion The selective decompression of nerve root canal under direct vision can achieve effective local decompression with protection of spinal stability as much as possible. Moreover, it has several advantages, such as significant improvement of the signs and symptoms, shorter operation time and less intraoperative blood loss.