手术治疗腰椎间盘突出合并马尾神经损伤疗效观察

Effect Analysis on Surgical Intervention of Lumbar Intervertebral Disc Herniation Combined with Cauda Equina Injury

目的观察腰椎间盘突出合并马尾神经损伤手术治疗的中短期疗效。方法回顾性分析2005年1月~2012年1月在我科进行手术治疗并随访3年的30例腰椎间盘突出症合并马尾神经损伤患者临床资料,比较手术前后症状恢复情况及ASIA神经功能评级。结果本组患者术后均随访3年,影像学资料显示植骨愈合良好,椎管通畅,无加重病例发生,术后1年内ASIA神经损伤评分明显改善者10例（33.3%）,术后2~3年ASIA神经损伤评分无明显进一步改善。结论腰椎间盘突出症合并马尾神经损伤一经诊断应及早手术治疗,选择双侧可扩张通道下椎间盘切除植骨融合能获得较好的效果,但由于马尾神经损伤的特点,短期可得到一定程度的恢复,中远期难以进一步康复。

Objective To observe the efficacy on surgical intervention of lumbar intervertebral disc herniation combined with cauda equina injury. Method The clinical data of 30 cases with lumbar intervertebral disc herniation combined with cauda equine injury received surgical treatment from January 2005 to January2012 in our department were analyzed retrospectively. Results All cases were followed up more than 3years. The imaging exam showed well bone healing and unobstructed spinal canal. No patients get worse after the surgery. ASIA rating was achieved significant improvement in 10 cases（ 33. 3%） during 1 year after the surgery,but no significant further improvement during 2 to 3 years after the surgery. Conclusions The surgical treatment should be intervened early once the patients diagnosed lumbar intervertebral disc herniation with cauda equina injury. The surgical procedure of posterior bilateral discectomy and fusion can achieve improvement,including surely recovery in short-term and poor further recovery in long-term.