下腰段脊神经根鞘膜切开减压术的评价

Incision of the Sheath of Schwann for Low Lumbar Nerve Roots decompression: A Prospective Study of 50 Cases

目的：腰椎间盘突出症手术治疗大多数效果优良，术后腰腿痛症状很快解除，而患足（趾）麻木却迁延很长一段时间。本文旨在观察脊神经根鞘膜切开减压对缓解病人术后患足（趾）麻木的效果。方法：选择５０例腰椎间盘突出症术前患足麻木症状重，术中见受累神经根明显增粗者，在行髓核切除的同时，将增粗的脊神经鞘膜切开。手术要点是用神经拉钩将神经根挑起，在其后外侧做全长的纵行切开，直至露出其下成束的神经纤维。并与术前麻木重，术中见神经根增粗而未做鞘膜切开的２０例做比较。结果：切开减压的５０例术后麻木症状完全消失时间平均为５．２（０～９）天。对照组的２０例平均为４（２～７）个月。结论：脊神经根鞘膜切开减压，能迅速缓解腰椎间盘突出症病人术后患足（趾）的麻木症状。

Objective: To evaluate the effects of the incision of the sheath of Schwann of low lumbar spinal nerve roots on the alleviation of numbness in foot or toe. Methods: Fifty patients with lumbar disc protrusion and symptoms of numbness in foot or toe were selected as experimental proup. Lumbar discectomy and incision of the sheath of Schwann of the nerve roots were performed, which included longitudinal incision of the full lengh of the lumbar spinal nerve roots until complete decompression and the nerve tracts were clearly seen. Another 20 patients with the same lesions and similar symptoms underwent discectomy alone served as controls. Results: The numbness in foot or toe lasted for an average of 5.2 days (0 to 9 days ) in the experimental group and 4 months (2 to 7.5 months) in the controls postoperatively. Conclusions: Incision of the sheath of Schwann of lumbar spinal nerve root could alleviate the symptom of numbness in foot or toe in the patients with lumbar disc protrusion.