伴马尾神经沉降征阳性腰椎管狭窄症患者的手术疗效观察

Operation effect observation of lumbar spinal stenosis with positive sedimentation sign of cauda equina nerve

目的分析马尾神经沉降征（SS）在腰椎管狭窄症中的表现特点,以及行改良腰椎后路椎体间融合术（PLIF）治疗的临床疗效。方法回顾分析2013年1月~2O14年6月上海长征医院脊柱外科收治的LSS患者126例的临床资料,依据仰卧位MRI横断面马尾神经是否沉降分为SS阳性组和SS阴性组。采用日本骨科学会（JOA）评分标准（29分法）,比较两组患者的术前、术后3个月和末次随访的疗效。结果 SS阳性患者109例,SS阴性患者17例,SS阳性发生率为86.5%。SS阳性组JOA评分术前、术后3个月及末次随访分别为（10.2±3.4）、（22.3±3.1）、（23.1±2.3）分,术后JOA评分均较术前升高（P〈0.05）;SS阴性组JOA评分术前、术后3个月及末次随访分别为（11.1±4.4）、（21.4±5.4）、（23.6±3.1）分,术后JOA评分均较术前升高（P〈0.05）;但是,两组患者术前及术后JOA评分差异无统计学意义（P〉0.05）。结论 SS阳性广泛存在于腰椎管狭窄患者中,并不影响患者术后疗效,SS阳性仍无法作为手术效果的预判指标,改良PLIF手术对SS阳性患者效果确切。

Objective To analyze the characters of cauda equina nerve root sedimentation sign（SS） in patients with lumbar spinal stenosis and the effect of posterior lumbar interbody fusion（PLIF）. Methods The clinical data of 126 patients with LSS underwent modified PLIF surgery in Shanghai Changzheng Hospital from January 2013 to June 2014 were retrospective analyzed. According to the supine MR examination, the cases were divided into positive SS group and negative SS group. Japanese Orthopaedic Association（JOA-29） score system was respectively used to evaluate the treatment effect before operation, 3 months after operation and last follow-up. Results There were 109 cases with positive SS and 17 cases with negative SS. The incidence of positive SS was 86.5%. The JOA scores in SS positive group were respectively（10.2±3.4）,（22.3±3.1）,（23.1±2.3） scores before operation, 3 months after operation and last follow-up, the JOA scores increased after operation（P 0.05）. The JOA scores in SS positive group were respectively（11.1±4.4）,（21.4±5.4）,（23.6±3.1） scores before operation, 3 months after operation and last follow up, The JOA scores also increased after operation（P 0.05）. However, there was no difference of JOA scores between two groups before and after operation（P 0.05）. Conclusion SS is commonly found in the lumbar spinal stenosis patients, and it does not influent the postoperative outcome. However, SS is not still considered as the predict factor of postoperative effect. The modified PLIF surgery is a valid treatment method for SS positive patients.