单侧症状的双侧腰椎神经根管狭窄行单、双侧减压的前瞻性研究

Unilateral and bilateral decompression for lumbar bilateral nerve root canal stenosis with unilateral symptoms: a prospective study

中文关键词:  后路斜向腰椎关节融合术  腰椎管狭窄症  减压术

英文关键词:Posterior oblique lumbar arthrodesis  Lumbar spinal stenosis  Decompessive surgery

中文摘要:

  【摘要】 目的：探讨腰椎同一节段双侧神经根管狭窄伴单侧症状患者行单侧减压或双侧减压的治疗效果。方法：对同一节段双侧腰椎神经根管狭窄伴单侧症状患者80例，前瞻性随机分为行单侧减压组（A组）和双侧减压组（B组），均行后路斜向腰椎关节融合术（posterior oblique lumbar arthrodesis，POLAr）治疗，分别观察术前、术后腰痛及患肢疼痛的VAS评分，记录手术时间，采用统一的临床功能评估标准评估临床疗效，观察并发症发生情况。结果：术后随访11～30个月，平均18个月。每节段手术时间A组为136.3±42min，B组为152.6±38min，两组间差异有显著性（P＜0.05）。两组术后1、3、6个月及末次随访时腰痛及患肢疼痛VAS评分与术前比较差异有显著性（P<0.05）。根据临床功能评估标准， A组优28例，良3例，可4例，差5例，临床优良率为77.5％（31/40）；B组优35例，良2例，可3例，临床优良率为92.5％（37／40），两组间差异有显著性（P<0.05）。所有病例均未出现切口或深部感染；A组中出现对侧下肢根性疼痛5例，分别行对侧腰椎神经根管封闭术或对侧神经根管减压术后缓解，出现术后一过性节段性感觉运动减退1例，经对症及神经营养药物治疗3周后恢复；B组未出现下肢根性疼痛病例，出现术后一过性节段性感觉运动减退1例，经对症及神经营养药物治疗2周后恢复；两组之间并发症发生率有显著性差异（P<0.05）。结论：单侧症状的双侧腰椎神经根管狭窄者行双侧减压与单侧减压相比，虽然手术时间较长，但根性疼痛并发症发生率低，临床优良率高。

英文摘要:

  【Abstract】 Objectives: To prospectively assess the outcome of unilateral decompression alone vs bilateral decompression for bilateral nerve root canal stenosis and with unilateral symptoms. Methods: Eighty cases with lumbar bilateral nerve root canal stenosis with unilateral symptoms undergoing posterior oblique lumbar arthrodesis(POLAr) were randomized into a unilateral decompression(group A) or a bilateral decompression group(group B). Both groups were performed POLAr surgery and evaluated by visual analogue scale(VAS) scores at pre-operation and post-operation. Operation time was recorded. The clinical outcomes and complications were evaluated afterwards. Results: All patients received 11 to 30 months′ follow-up, with an average of 18 months. Both groups showed significant improvement on low back pain and leg pain VAS scores at 1, 3, 6 months after the operation and the final follow-up(P<0.05). The rate of satisfactory clinical results was 77.5％ for group A and 92.5％ for group B(P<0.05). There was no incision infection and deep infection in both groups. Five patients in group A suffered from lower limb radicular pain on the contralateral side. One in group A suffered from transient segmental numbness and weakness on the ipsilateral side and recovered by correspondent treatment and neurotrophic therapy for 3 weeks. Four of them relived with epidural blockade on the contralateral side. One of them failed from epidural blockade and recovered after contralateral decompression. Only one patient in group B showed transient segmental numbness and weakness on the ipsilateral side and recovered by correspondent treatment and neurotrophic therapy for 2 weeks after the surgery. The incidence rate of complications was 15.0% for group A and 2.5% for group B(P<0.05). Conclusions: Campared with unilateral decompression of lumbar bilateral nerve root canal stenosis with unilateral symptoms, bilateral decompression is less likely to develop nerve root pain, which has better excellent to good results despite of longer surgical time.