腰椎间盘突出症致马尾神经综合征的手术治疗

Surgery to the cauda equina syndrome secondary to lumbar disc herniation

目的探讨腰椎间盘突出症所致马尾神经综合征的临床分型、手术时机及手术方式对疗效的影响。方法对53例腰椎间盘突出症致马尾神经综合征患者行手术治疗,对临床分型、手术时机、手术方式的疗效进行分析。结果 53均获得随访,时间1～7年,平均(29.9±19.2)个月。各临床分型的疗效比较差异无统计学意义(P>0.05);Ⅰ、Ⅱ型患者48 h内手术与48 h后手术的疗效比较差异有统计学意义(P<0.05);全椎板切除与椎板间开窗和半椎板切除的疗效比较差异有统计学意义(P<0.05);椎板间开窗与半椎板切除的疗效比较差异无统计学意义(P>0.05);术中是否加用内固定的疗效比较差异无统计学意义(P>0.05)。结论腰椎间盘突出致马尾神经综合征患者发病48 h内手术疗效好,手术应彻底减压;若术后存在腰椎不稳,建议使用椎间融合内固定。

Objective To evaluate the clinical classifications, operative timing, methods and the effect of surgical treatment of cauda equina syndrome （CES） secondary to lumbar disc herniation （LDH）. Methods 53 patients with CES secondary to LDH were treated by surgery operation. The clinical classifications, operative timing, methods and the effect of surgical treatment were analyzed comprehensively. Results All the 53 cases were followed up for 1 -7 years （average 29.9 ± 19. 2 months）. There was no significant statistical difference on therapeutic effects between different clinical classifications （P 〉 0.05 ）. In the clinical classification I and II patients, there was significant statistical difference on therapeutic effects between the patients underwent operation within 48h and more than 48h （P 〈 0. 05 ）. There was significant statistical difference on therapeutic effects between the patients underwent ＂all lamina cutting＂ and the patients underwent ＂intervertebral space＂ or ＂hemi-lamina cutting＂ （P 〈 0.05 ）. There was no significant statistical difference on therapeutic effects between the patients underwent ＂intervertebral space＂ and the patients underwent ＂hemi-lamina cutting＂ （ P 〉 0. 05 ）. There was no significant statistical difference on therapeutic effects between the patients with internal fixation and the patients without internal fixation. Conclusions Patients with CES secondary to LDH were treated by surgery operation within 48h received good therapeutic effects. The vertebra canal should be thoroughly decompressed during surgery operation. The pedicle screw fixation and lumbar interbody fusion should be advised to patients with lumbar instability after surgery operation.