腰椎退变性疾病致足下垂的临床特点及其预后影响因素

Clinical features and prognostic factors of foot drop caused by lumbar degenerative disease

中文关键词:  足下垂  腰椎退变性疾病  预后  影响因素

英文关键词:Foot drop  Lumbar degenerative disease  Prognosis factors  Outcome

中文摘要:

  【摘要】 目的：分析腰椎退变性疾病致足下垂的临床特点，探讨影响其预后的因素。方法：2005年1月~2010年1月，手术治疗1674例腰椎间盘突出症和/或腰椎管狭窄症患者，其中135例合并足下垂，男62例，女73例；年龄43~64岁，平均55岁。术前胫前肌肌力：0级18例，1级34例，2级59例，3级24例。均行椎弓根螺钉内固定、神经根减压、改良腰后路椎间融合术治疗。术后随访1~2年，平均1.3年，观察胫前肌肌力恢复情况。统计患者年龄、性别、病程、术前胫前肌肌力、下肢感觉障碍、受累足、受压神经根，分析其对术后胫前肌肌力恢复的影响。结果：足下垂占同期患者的8.1%。43例（32.8%）单条神经根受压（L5 34例，S1 7例，L4 2例），83例（61.5%）2条神经根受压（L5、S1 56例，L4、L5 27例），9例（6.7%）3条神经根受压（L4、L5、S1）。共有126例患者（93.3%）L5神经根受压。术后113例（83.7%）患者胫前肌肌力有所恢复，其中21例（15.6%）恢复至4级及以上。术后6个月随访时患者胫前肌肌力恢复基本稳定。末次随访时患者胫前肌肌力：1级28例，2级24例，3级62例，4级13例，5级8例。足下垂病程、术前胫前肌肌力和患者年龄与手术效果相关。结论：在腰椎退变性疾病致足下垂的患者中L5神经根受压最常见，多条神经根受压常见；足下垂一旦发生，预后不佳；足下垂病程、术前胫前肌肌力以及年龄是影响胫前肌肌力恢复的重要因素，应预防其发生及早期治疗。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical features and surgical outcome of foot drop due to lumbar degenerative disease and to determine risk factors. Methods: 1674 patients who suffered from lumbar disc herniation and/or lumbar spinal stenosis and underwent lumbar surgery from January 2005 to January 2010 were reviewed. A total of 135 patients with foot drop was included. There were 62 males and 73 females with a mean age at surgery of 55 years(range, 43-64 years). The tibialis anterior strength was 0, 1, 2, 3 level in 18, 34, 59, 24 patients respectively. All patients underwent modified PLIF and nerve roots decompression. The mean follow-up period was 1.3 years(range, 1-2 years). The clinical features and mechanism were analyzed. Age, sex, duration of palsy, preoperative tibialis anterior strength, numbness of affected lower limb, affected foot and nerve root compression were recorded and compared to determine the risk factors. Results: Foot drop was observed in 8.1% of all inpatients. Single, double and triple nerve root compression was noted in 43, 83, and 9 patients(32.8%, 61.5%, and 6.7%) respectively. L5 nerve root entrapment was observed in 126 of all 135 patients(93.3%). 113 patients(83.7%) had foot drop recovered after surgery, the tibialis anterior strength reached to 4 level or above in 21(15.6%) patients. The tibialis anterior strength remained unchanged at 6 months. At final follow-up, the tibialis anterior strength was 1, 2, 3, 4, 5 level in 28, 24, 62, 13, 8 patients respectively. The statistical analysis showed duration of palsy, preoperative tibialis anterior strength and age were risk factors that influenced recovery after operation. Conclusions: L5 nerve root palsy is most common in patients suffering from foot drop due to lumbar degenerative disease. Multilevel nerve root entrapment was not uncommon, which has bad prognosis. The course of disease, preoperative tibialis anterior strength and younger age are risk factors, and early prevention and intervention is critical.