腰椎后路内固定术后神经根损伤性肌肉麻痹的因素分析

Factor analysis of muscular paralysis due to nerve root injury after posterior lumbar interbody fusion(PLIF)

目的:对腰椎后路内固定及融合术后出现神经根损伤性肌肉麻痹的因素进行分析研究。方法:自2001年1月至2012年1月实施PLIF手术1250例,对其中29例术后出现神经根损伤性肌肉麻痹的患者术前诊断、手术过程、术后症状等临床资料进行回顾性分析。29例患者中,男10例,女19例;年龄49～82岁,平均61岁。内固定椎间融合手术节段:单节段为12例,双节段14例,3节段3例。结果:29例患者术后随访均超过1年,最长为2年半,平均1年7个月。23例随访结果满意,受累肌力恢复到4～5级,3例患者随访效果较差,最终肌力为0～2级。术后恢复的时间与损伤程度成正比,术后肌力在2级以上的患者大部分2周之内即可有明显改善。结论:PLIF术后神经根损伤性肌肉麻痹的因素较为复杂,如果不存在严重碾挫伤及离断伤,多数患者可以获得满意的恢复效果。

Objective：To analyze the reasons of muscular paralysis due to nerve root injury after PLIF. Methods：From January 2001 to January 2012,1 250 cases underwent PLIF in our hospital, after operation, 29 cases occurred muscular paralysis due to nerve root injury. There were 10 males and 19 females with an average age of 61 years, 12 cases with one-segment, 14 cases with two-segment, 3 cases with three-segment. The clinical data of 29 patients were retrospectively analyzed including PODx （preoperative diagnosis）, surgery procedure,postoperative symptoms and so on. Results：The follow-up time was more than 1 year and the longest was 2.5 years with an average of 1 year and 7 months. Twenty-three patients obtained satisfactory results and muscle strength recovered to 4-5 levels, 3 patients was poor and final muscle strength recovered to 0-2 levels. Recovering time after operation was directly proportional to the degree of injury, those muscle strength level was more than 2, usually could have significant improvement within 2 weeks. Conclusion：More complicated factors result in the reasons of nerve root injury after PLIF. Except those suffered severe grinding contusion and amputation, most of the patients can get satisfactory effect.