颈腰综合征诊断及外科治疗的研究进展

Research progress on diagnosis and treatment for tandem spinal stenosis

目的总结颈腰综合征(TSS)诊断和外科治疗的研究进展。方法在中国知网、万方数据、中国生物医学文献数据库和PubMed数据库,分别以“颈腰综合征”“椎管狭窄”“颈椎”“腰椎”“同期手术”“分期手术”和“tandem spinal stenosis”“canal stenosis”“cervical”“lumber”“simultaneous”“staged”为关键词,检索2000年1月—2019年2月与TSS的解剖学、流行病学、临床表现、影像检查、外科治疗有关的文献进行分析总结。共检索文献489篇,纳入45篇,其中中文文献15篇和英文文献30篇。结果TSS的发病率为0.12%~34%,好发年龄为20~76岁,临床表现复杂,应综合评估患者症状和体征,并结合多种影像学证据才能明确诊断。其手术治疗方式存在争议,目前多数研究认为同期手术和分期手术在手术疗效和并发症方面没有统计学差异。同期手术可缩短手术时间、住院时间和住院费用。分期手术单次手术创伤小,对于耐受差的老年患者更适用;部分患者在主要受压部位减压后,次要受压部位的症状可能同时得以缓解从而避免二期手术治疗。结论TSS在当代脊柱外科临床中并不少见,全面的体格检查和影像学评估,能更有效地发现多部位压迫,依据病变程度选择同期或分期手术均能获得满意的临床疗效。

Objective To summarize the progress of tandem spinal stenosis(TSS)to provide a theoretical basis for the clinical diagnosis and treatment.Methods A computer-based online search of CNKI,Wanfang Data,China Biology Medicine Disc and PubMed databases were undertaken to identify the articles about TSS published from January 2000 to February 2019,with the key words of“tandem spinal stenosis”“spinal stenosis”“cervical vertebrae”“lumber vertebrae”“simultaneous operation”“staging operation”.The anatomy,epidemiology,clinical feature,imaging and surgical treatment were summarized.A total of 489 related literatures were retrieved,and 45 literatures were finally included according to the inclusion and exclusion criteria,including 15 Chinese literatures and 30 English literatures.Results The incidence of TSS was 0.12%to 34%,and the age of onset was 20-76 years old.The clinical manifestation of TSS was complex.The patients'symptoms,signs and imaging evidence should be comprehensively evaluated.The surgical procedures were controversial.Most studies showed that there was no statistical difference in operative efficacy and complications between staged operation and simultaneous operation.But simultaneous operation could shorten operation time,hospitalization days and costs.The surgical trauma of staged operation was less,which was more suitable for the elderly patient with poor tolerance.After first-stage operation,the symptoms might be relieved and the second-stage operation might be avoided.Conclusions TSS is not rare in contemporary spine surgery.Comprehensive physical examination and imaging evaluation are necessary to discover the multiregional spinal stenosis.TSS can be effectively managed by either simultaneous surgical intervention,or staged decompressions.