后路腰椎椎间融合术并发神经损伤的原因分析

Analysis of neurologic complications after posterior lumbar interbody fusion

中文关键词:  腰椎  后路椎间融合术  神经损伤  并发症

英文关键词:Lumbar vertebra  Posterior interbody　fusion  Nerve injury  Complication

中文摘要:

  【摘要】 目的：分析后路腰椎椎间融合术并发神经损伤的原因。方法：2003年3月~2008年5月采用后路腰椎椎间融合术（PLIF）治疗腰椎疾病患者178例，其中腰椎间盘突出症42例，腰椎管狭窄症39例，退变性腰椎滑脱症61例，峡部裂性腰椎滑脱症22例，腰椎椎板/椎间盘切除术后综合征14例；单节段融合130例，其中L3/4 8例，L4/5 64例，L5/S1 58例，双节段融合46例，其中L3/4、L4/5 19例，L4/5、L5/S1 27例，三节段融合2例，均为L3/4、L4/5、L5/S1，对其发生神经损伤的原因进行分析。结果：共并发神经损伤13例（7.3%），其中L4 1例，L5 7例，S1 5例；神经根牵拉伤6例，器械损伤3例，误伤变异神经根1例，硬膜外血肿致神经根受压1例，椎弓根骨折致神经根受压1例，继发性侧隐窝狭窄致神经根受压1例；完全性损伤2例，不完全性损伤11例。根据ASIA评分标准，神经功能完全恢复7例，部分恢复4例，无恢复2例。结论：后路腰椎椎间融合术并发神经损伤的原因是多方面的，以神经根的牵拉伤最多见。

英文摘要:

  【Abstract】 Objective：To evaluate the neurologic complications associated with posterior 1umbar interbody fusion（PLIF）.Method：From March 2003 to May 2008，a total of 178 patients experienced PLIF procedure due to lumbar disease.Of these，forty two had lumbar disc herniation，39 had lumbar spine stenosis，61 had degenerative spondylolisthesis，22 had isthmic spondylolisthesis and 14 had post-laminectomy/discectomy syndrome.One hundred and thirty patients had single level fused，of these，8 at L3/4，64 at L4/5 and 58 at L5/S1.Forty six cases had two levels fused，of these，19 at L3/4 and L4/5，27 at L4/5 and L5/S1.Two patients had three levels fused，all at the L3/4，L4/5 and L5/S1.All causes possibly related to the neurologic complications were documented．Result：13 cases（7.3%） were noted to have neurologic complications，of these，one at L4，7 at L5 and 5 at S1.6 cases had nerve root stretch injury，3 cases had nerve root injury from instrument maneuver，1 case had nerve root deformity，1 case had developed epidural hematoma，1 case had nerve root injury from pedicle fracture and 1 case had secondary lateral recess stenosis.2 cases had complete neurological injury，and 11 cases had incomplete injury.According to American Spinal Injury Association（ASIA） criteria，there was complete recovery of neurologic function in 7 cases，incomplete recovery in 4 cases and no change in 2 cases.Conclusion：Many causes may be associated with the neurologic complications due to posterior 1umbar interbody fusion，nerve root stretch injury is the most common.