腰椎斜外侧椎间融合术后交感神经链损伤的临床特征分析

Clinical characteristics of sympathetic chain injury after oblique lateral interbody fusion: underestimated incidence

中文关键词:  腰椎退变性疾病  斜外侧椎间融合术  腰交感神经链损伤

英文关键词:Lumbar degenerative diseases  Lumbar sympathetic chain injury  Oblique lateral interbody fusion

中文摘要:

  【摘要】 目的：分析腰椎斜外侧椎间融合术（oblique lumbar interbody fusion，OLIF）后交感神经链损伤（sympathetic chain injury）的临床特征，并统计其发生率。方法：回顾性分析2016年4月～2017年12月在我院骨科行OLIF的54例腰椎退行性疾病患者，其中男性10例，女性44例；年龄37～80岁（58.4±10.9岁）。腰椎滑脱症18例，腰椎不稳12例，腰椎间盘突出症8例，腰椎退变性侧凸14例，腰椎间盘突出症术后复发2例。单节段OLIF 39例，多节段OLIF 15例。左侧入路52例，右侧入路2例。术前采用电子感应体温仪测量双小腿及双足背体表温度，术后次日采用同样方法测量双小腿及双足背体表温度，将双小腿或足背温度差≥0.5℃定义为双下肢温度不等，并诊断为腰交感神经链损伤，记录所有患者术后下肢症状，术后1周、6周、6个月、2年随访时采用Likert五分量表法评价患者对交感神经链损伤引起的不适体验。结果：54例患者术前双下肢体表温度差异不具有统计学意义（P＞0.05）。术后16例（29.6%）存在双下肢体表温度温度差≥0.5℃，诊断为交感神经链损伤。其中女性15例（34.1%），男性1例（10%），女性患者较男性患者发生率高，但差异无统计学意义（P＞0.05）；腰椎滑脱4例（4/18，22.2%），腰椎不稳4例（4/12，33.3%），腰椎间盘突出症（3/8，37.5%），腰椎退变性侧凸（5/14，35.7%），差异无统计学意义（P＞0.05）；单节段OLIF 10例（24%），多节段6例（46%），多节段患者的发生率显著性高于单节段患者（P<0.05）。术后8例（14.8%）自我感觉双下肢皮温不等，12例（22.2%）患者出现大腿前方疼痛、麻木感、股四头肌乏力，二者在有交感神经链损伤患者和无交感神经链损伤患者的分布无统计学差异（P＞0.05）。16例交感神经链损伤患者术前左小腿温度为36.1±0.2℃，右小腿36.1±0.3℃，左足温度为36.0±0.2℃，右足35.9±0.3℃，术后左小腿温度为36.7±0.3℃，右小腿36.1±0.3℃，左足温度为36.7±0.3℃，右足35.8±0.4℃，术后第一天双小腿温差0.6±0.1℃，足部温差0.9±0.3℃，足部温差较小腿明显；温差不等持续1.5～12个月。术后1周主观体验Likert五分量表法评定：差2例（12.5%），中等14例（87.5%）；6周时2例改善，6个月时6例改善，其中1例差改善为中等，至术后2年随访，2例由差改善至中等，7例由中等改善至良好。结论：电子感应体温仪测量双下肢体表温度可协助诊断，多节段OLIF患者的交感神经链损伤发生率高于单节段OLIF，大部分患者对双下肢温度不等的主观体验为中等不适。

英文摘要:

  【Abstract】 Objectives： To investigate the incidence and clinical characteristics of sympathetic chain injury after oblique lateral lumbar interbody fusion(OLIF). Methods： The data of 54 patients with lumbar degenerative diseases who underwent OLIF in the Department of Orthopedics of our hospital from April 2016 to December 2017 were retrospectively analyzed, which included 10 males and 44 females, aged 37-80 years (58.4±10.9 years). There were 18 cases of lumbar spondylolisthesis, 12 cases of lumbar instability, 8 cases of lumbar disc herniation, 14 cases of lumbar degenerative scoliosis, and 2 cases of postoperative recurrence of lumbar disc herniation. Of all patients, single segment OLIF was performed in 39 cases and multi-segment OLIF was performed in 15 cases, and left approaches were adopted in 52 cases, while right approaches were adopted in 2 cases. The body surface temperature of both legs and dorsum of both feet was measured by electronic induction thermometer before operation and on the next day after operation, and the temperature difference of both legs or dorsum of feet ≥0.5℃ was defined as the temperature difference of lower limbs, and lumbar sympathetic chain injury was diagnosed. The symptoms of lower limbs after operation were recorded. The patients were followed up at 1 week, 6 weeks, 6 months and 2 years after operation, using Likert five-scale to evaluate the discomfort experience caused by sympathetic chain injury. Results： There was no statistically significant difference in the surface temperature of both lower limbs before operation in 54 patients(P>0.05), and there was unequal surface temperature of both lower limbs in 16 patients(29.6%) after operation, including 15 women(34.1%) and 1 man(10%). The incidence of female patients was higher than that of male patients, but the difference was not statistically significant(P>0.05), including 4 cases of lumbar spondylolisthesis (4/18, 22.2%) and 4 cases of lumbar instability(4/12, 33.3%), Lumbar disc herniation(3/8,37.5%) and lumbar degenerative scoliosis(6/14, 35.7%), the difference was not statistically significant(P>0.05); There were 10 patients with single segment(24%) and 6 patients with multi segment(46%). The incidence of multi segment OLIF was significantly higher than that of single segment OLIF(P<0.05). After operation, 8 patients(14.8%) felt that the skin temperature of both lower limbs was unequal, and 12 patients(22.2%) had pain, numbness and quadriceps femoris weakness in front of thigh. There was no significant difference between patients with sympathetic chain injury and patients without sympathetic chain injury(P>0.05). The temperature of left leg was 36.1±0.2℃, that of right leg was 36.1±0.3℃ and that of left foot was 36.0±0.2℃, The temperature of the right foot was 35.9±0.3℃, the temperature of the left leg was 36.7±0.3℃, the temperature of the right leg was 36.1±0.3℃, the temperature of the left foot was 36.7±0.3℃, the temperature of the right foot was 35.8±0.4℃, the temperature difference between the two legs was 0.6±0.1℃ and the temperature difference between the feet was 0.9±0.3℃ on the first day after operation; The temperature difference varies for 1.5-12 months. One week after operation, the subjective experience was evaluated by Likert five subscale method: poor in 2 cases(12.5%), medium in 14 cases(87.5%); 2 cases improved at 6 weeks and 6 cases improved at 6 months, of which 1 case improved from poor to medium. After 2 years of follow-up, 2 cases improved from poor to medium, and 7 cases improved from medium to good. Conclusions： The measurement of the surface temperature of both lower limbs by electronic induction thermometer can assist the diagnosis. The incidence of sympathetic chain injury in patients with multi-level OLIF is higher than that in patients with single-level OLIF. The subjective experience of sympathetic nerve chain injury in most patients was moderate discomfort.