腰椎间盘突出症致马尾神经综合征手术时机的临床研究

Timing of surgery for cauda equina syndrome due to lumbar disc herniation:a clinical analysis

[目的]探讨腰椎间盘突出症致马尾神经综合征手术时机的选择。[方法]回顾性分析148例腰椎间盘突出症致马尾神经综合征患者临床资料,根据术前是否进行鞍区感觉评分及肛门括约肌压力测量分为治疗组(65例)和对照组(83例)。治疗组进行鞍区感觉评分,测量肛门括约肌静息压力及收缩压力,分析压力梯度变化,评价马尾神经损伤程度,根据评定分别予以急诊手术(24 h以内)、限期手术(48 h以内)及择期手术治疗。对照组根据发病时间安排手术治疗。将术后并发症发生率及随访结果进行比较。[结果]治疗组术后并发症发生率为3.1%,对照组并发症发生率为6.0%,治疗组并发症发生率与对照组无显著性差异(P>0.05);随访结果显示术前、术后3个月及术后18个月组内ODI评分比较均有显著性差异(P<0.05),而术后18个月治疗组与对照组间无显著性差异(P>0.05)。术后18个月治疗组泌尿系统恢复情况好于对照组(P<0.05)。[结论]马尾神经综合征的手术时机选择可根据患者鞍区感觉评分及肛门括约肌压力梯度变化来确定,而不是以简单的发病时间来做机械的界定。

[Objective] To analyze the impact of the timing of surgical intervention on the clinical outcome of cauda equina syndrome（CES） following surgery for herniated lumbar discs. [Methods]The clinical data on 148 patients with CES following operation for lumbar disc herniation were collected.In 65 of the patients（treatment group）,sensory assessment in the saddle area and measurement of the changes in anal sphincter resting and contraction pressure gradient were carried out to evaluate the severity of cauda equina injuries prior to surgical intervention,and subsequent emergency surgery（within 24 h after CES onset）,surgery within 48 h or elective surgery were performed accordingly.The other 83 patients received early surgical interventions upon diagnosis of CES without preoperative assessments（control group）.The postoperative complications and clinical outcomes were compared between the two groups. [Results]The incidence of postoperative complications showed no significant difference between the treatment and control groups（3.1% vs 6.0%,P0.05）.The Oswestry Disability Index（ODI） scores underwent significant changes at 3 and 18 months after the surgery in both groups（P0.05）,but between the two groups the scores were comparable at 3 and 18 months postoperatively（P0.05）.The follow-up examination at 18 months showed better recovery of the urinary functions in the treatment group than in the control group（P0.05）. [Conclusion]Instead of the arbitrary timing simply according to the time of CES onset,the decision on the timing of surgical intervention of CES can be made based on sensory assessment of the saddle area and anal sphincter pressure gradient changes in the patients.