下腰椎骨折并发马尾综合征的手术疗效分析

目的:马尾综合征(CES)包括下腰痛、坐骨神经痛、下肢运动感觉功能障碍、会阴区麻木,以及膀胱直肠功能障碍或丧失,CES的一些认识已经明确,但是临床上采取什么样的治疗最恰当存在争议,有关腰椎间盘突出引起的CES,已经积累了大量的病例资料。但是有关下腰椎骨折引起的马尾综合征临床少有报道。方法:从1998年到2006年,收集17例L2—5腰椎骨折并发马尾综合征的病人,其中车祸伤11例,高处坠落伤6例,脊髓圆锥损伤导致的CES的病例除外,记录所有病例的体征、受伤机制、影像资料、受伤时间、手术方法、神经损伤和恢复情况。结果:所有病例随访至少12个月。所有的病人在出现CES48小时之内进行手术减压治疗,其中14个病人恢复效果满意,另外3个病人虽然在伤后24小时内进行了手术治疗,但是效果不好。双下肢无力在4个月内恢复,膀胱和直肠功能在3个月恢复。总的来看,病人恢复效果的好坏与手术时间的早晚无关。结论根据临床研究,下腰椎骨折引起的CES恢复效果与受伤时马尾损伤的程度密切相关,虽然对于手术的时机存在争议,但是本研究建议在出现CES48小时内施行手术治疗。

Clinical Study of Cauda Equina Syndrome in Patients with Low Lumbar Fractures

Objective:Symptoms of cauda equina syndrome(CES)can include low-back pain,sciatica,lower-extremity weak- ness,sensory deficit,perineal hypesthesia or anesthesia,and loss of bowel or bladder function.Several causes of the syndrome are recognized,but its optimal treatment remains controversial and has been broadly based on data gathered from series involving her- niated discs.Information on the treatment of CES caused by low lumbar traumatic injuries has not been well documented.Meth- ods:Resnlts January 1998 and December 2006,17 consecutive cases of CES caused by low lumbar traumatic injuries at L2-5 were identified.The traumatic injuries consisted of motor vehicle accident in 11,and a fall from height in 6.Conus medullaris in- juries causing CES were excluded from this review.Presenting symptoms,mechanisms of injury,radiographic images,timing of surgery,surgical approaches,and neurological status at the final follow up were documented.Results:All patients underwent fol- low up of at least 12 months.Fourteen of 17 patients had satisfactory outcomes.Despite undergoing surgery within the first 24 hours postinjury,three patients had what was classified as a poor outcome given their residual deficits.Recovery of leg weakness occurred within 4 months,whereas bladder and bowel function recovered within 3 months.All patients in this series underwent decompression within less than 48 hours after syndrome onset.Overall,the authors found no difference regarding timing of sur- gery between patients in the satisfactory outcome group and those in the poor outcome group.Conclusion:Based on the evidence in this study,the severity of a patient's condition on initial presentation should be the most crucial factor in predicting outcome fol- lowing CES due to low lumbar injuries.Although the matter of the timing of surgery might remain controversial,the authors of this study recommended that surgery be performed within 48 hours of syndrome onset.