腰椎管狭窄合并马尾神经冗余患者的手术疗效分析

目的观察腰椎管狭窄症(LSS)患者马尾神经的MRI表现特点,分析行后路腰椎内固定椎间融合术(PLIF)治疗的临床疗效,探讨马尾神经冗余(RNRs)对手术疗效和预后判断的临床价值。方法收集经临床确诊且行PLIF术治疗的腰椎管狭窄患者209例。按腰椎MRI T2WI矢状面椎管内马尾神经是否冗余分组。测量腰椎管最狭窄处硬膜囊横截面积(CSA),对患者术前及术后进行腰椎Oswestry功能障碍指数(ODI)评分和视觉模拟评分法(VAS)评分。结果 RNRs组85例,非RNRs组(对照组)124例,冗余发生率为40.7%。RNRs组较对照组患者年龄大、椎管狭窄程度严重、ODI评分及VAS评分高(P<0.01),2组间性别比例差异无统计学意义(P>0.05)。经PLIF术治疗后,RNRs组患者中有68例RNRs解除(解除组),17例RNRs未解除(未解除组),RNRs未解除率为20.0%。未解除组术后ODI及VAS评分较解除组和对照组均高(P<0.05);而解除组与对照组间临床评分差异无统计学意义(P>0.05)。结论 LSS患者的手术疗效评估关键在于术后RNRs是否解除,...

Analysis of surgical outcomes of lumbarspinal stenosis with redundant nerve roots

Objective To analyze the characteristics of redundant nerve roots (RNRs) in patients with lumbar spinal stenosis (LSS) by magnetic resonance (MRI), to observe the clinical outcome of posterior lumbar interbody fusion (PLIF) and to explore the clinical value of RNRs in the choice of operation and prognosis. Methods A total of 209 patients with LSS who were confirmed clinically and treated with PLIF were collected. The patients were divided into groups according to whether there were RNRs in the sagittal T2-weighted images of lumbar. The cross-sectional area (CSA) of the narrowest part of lumbar spine was measured. Lumbar Oswestry Disability Index (ODI) score and Visual Analogue Scale (VAS) score were made for patients before and after operation. Results There were 85 cases in the RNRs group and 124 cases in the nonRNRs group, and the incidence of RNRs was 40.7%. Compared with the control group, the age, the degree of spinal stenosis, ODI score and VAS score were higher in RNRs group (P＜0.01). There was no significant difference in sex ratio between the two groups (P＞0.05). After PLIF treatment, 68 patients were relieved RNRs in the RNRs group (relief group), and 17 patients were not relieved RNRs (unrelieved group), with an unrelieved rate of 20.0%. The postoperative ODI score and VAS score were significantly higher in the unrelieved group than those in the relief group and the control group (P＜0.05), but there were no significant differences in the clinical scores between the relief group and the control group (P＞0.05). Conclusion The key to evaluate the surgical outcomes of LSS is whether the postoperative RNRs are relieved. There is a relatively poor effect in patients who still have RNRs after surgery than that of patients with RNRs has been relieved after operation. RNRs can be used as the index of surgical prognosis.