腰骶神经弓弦病30例诊治分析

Lumbosacral nerve bowstring disease

目的提出腰骶神经弓弦病的定义和诊断标准并初步评价胶囊手术治疗效果。方法自2016年6至12月上海市长征医院第二脊柱外科诊断为腰骶神经弓弦病且需要接受手术治疗的患者共30例，男22例，女8例，年龄（55.1±9.7）岁。由于先天发育性因素致使腰骶神经轴性高张力，可伴有其他腰骶疾病或医源性因素损伤，导致神经损伤相关症状，定义为腰骶神经弓弦病。术中发现该类患者硬膜囊和神经根张力增大，并且患者症状随张力增加而加重，如绷紧的琴弦，两端牵张力越大，拨动发出的声音越洪亮，而脊柱腰骶部形态似一张弓，故以此命名。所有患者采用胶囊手术进行治疗，术前术后自主填写疼痛恐惧量表（TSK）、Oswestry功能障碍指数（ODI）问卷和视觉模拟评分法（VAS）评分。结果手术时间为（155±36）min，术中出血量为（558±97）ml；手术节段为（4.3±0.4）个节段。术前VAS、TSK和ODI评分分别为（7.6±0.8）、（52.0±10.3）、（68.4±12.7）分，术后分别为（3.3±0.4）、（24.6±5.2）、（32.1±7.4）分（P〈0.05）。无患者出现感染、神经损伤等并发症。 结论初步制定了腰骶神经弓弦病的定义和诊断标准，提出胶囊手术治疗方案，术后患者症状均大部分改善，生存质量得到显著提高。

ObjectiveTo define a novel disease-lumbosacral nerve bowstring disease, and propose the diagnostic criteria, while capsule surgery was performed and evaluated in the preliminary study. MethodsFrom June 2016 to December 2016, a total of 30 patients （22 male and 8 female; mean age of 55.1±9.7 years） with lumbosacral nerve bowstring disease were included in Department of Spine Surgery, Changzheng Hospital, the Second Military Medical University.Lumbosacral nerve bowstring disease was defined as axial hypertension of nerve root and spinal cord caused by congenital anomalies, which could be accompanied by other lesions as lumbar disc herniation, spinal cord stenosis or spondylolisthesis, or aggravated by iatrogenic lesions, resulting in neurological symptoms.This phenomenon is similar to a stretched string, the higher tension on each end the louder sound.Meanwhile, the shape of lumbosacral spine looks like a bow, thus, the disease is nominated as lumbosacral nerve bowstring disease.All the patients underwent capsule surgery and filled out Owestry disability index （ODI） and Tempa scale for kinesiophobia （TSK） before and after surgery. ResultsThe mean surgery time was （155±36） min, （4.3±0.4） segments were performed surgery.The pre-operative VAS, TSK and ODI scores were （7.6±0.8）, （52.0±10.3） and （68.4±12.7）, respectively.The post-operative VAS, TSK and ODI scores were （3.3±0.4）, （ 24.6±5.2） and （32.1±7.4）（P〈0.05, respectively）, respectively. ConclusionThe definition and diagnostic criteria of lumbosacral nerve bowstring disease was proposed.Capsule surgery was an effective strategy with most patients acquired excellent outcomes as symptoms relieved and quality of life improved.