浸润醋酸泼尼松龙的明胶海绵可改善后路腰椎间融合后根性症状

Gelatin sponge containing prednisolone acetate relieves radicular pain following posterior lumbar interbody fusion

背景:后路腰椎间融合对中央管减压彻底,对于下腰段偏中央型椎间盘突出合并椎间不稳的患者是常用的治疗方法,但其术中常需对硬膜囊和神经根进行牵拉,容易诱发术后早期的下肢根性痛。目的:观察神经根周围覆盖含醋酸泼尼松龙的明胶海绵对后路腰椎椎体间融合后根性症状的改善作用。方法:将63例单侧腰椎间盘突出症合并相应节段不稳患者,按植入物类型分为治疗组(n=21)和对照组(n=42),其中治疗组患者采取后路腰椎间融合后置入浸润醋酸泼尼松龙注射液的明胶海绵,对照组患者仅单纯置入明胶海绵。结果与结论:(1)与对照组相比,治疗组患者治疗后1周内下肢疼痛缓解明显,而6个月时2组目测类比评分和Oswestry功能障碍指数接近;(2)对照组术后有3例患者下肢痛复发,2组患者均未出现切口感染、硬膜外血肿等并发症;(3)提示后路腰椎间融合结合神经根周围覆盖醋酸泼尼松龙明胶海绵可有效改善腰椎间盘突出症患者术后早期的下肢根性疼痛,有利于早期进行康复锻炼,提升患者术后近期满意率。

BACKGROUND： Posterior lumbar interbody fusion can thoroughly decompress the central canal, which is the common surgical technique for the central type of lumbar disc herniation with intervertebral instability at low lumbar segment. However, due to the regular traction on dural sac and nerve root in the operation, lower limb radicular pain in the early stage is inevitable. OBJECTIVE： To evaluate the effect of local use of gelatin sponge containing prednisolone acetate around the nerve roots after posterior lumbar interbody fusion on lower limb radicular pain. METHED： Sixty-three cases of lumbar disc herniation with degenerative instability were devided into treatment group （n=21） and control group （n=42） based on the type of implants. Gelatin sponge containing prednisolone acetate was implanted into patients in the treatment group after posterior lumbar interbody fusion, while pure gelatin sponge was implanted into patients in the control group. RESULTS AND CONCLUSION： Compared with the control group, radicular pain in the treatment group was significantly relieved within 1 week after surgery. The visual analog scale score and Oswestry disability index score were similar between the two groups. There were three cases of radicular pain recurrence in the control group, but no incision infection and epidural hematoma after surgery in both two groups. In conclusion, local use of gelatin sponge containing prednisolone acetate around the nerve roots can significantly relieve lower limb radicular pain in the early stage after posterior lumbar interbody fusion in lumbar disc herniation, contributing to early rehabilitation exercise and patient satisfaction outcomes.