腰椎退行性疾病导致足下垂的临床特点及手术效果分析

Analysis of Clinical Features and Surgical Outcome of Drop Foot Attributable to Lumbar Degenerative Diseases

目的退行性腰椎疾病导致足下垂手术后的效果分析。方法我们回顾性分析了2008—2018年首都医科大学附属北京世纪坛医院143例腰椎退行性病变导致足下垂患者的临床特点、手术治疗和预后情况。把年龄、性别、术前麻痹持续时间、术前胫骨前肌(tibialis anterior,TA)力量等进行记录并与患者手术后的情况进行比较。结果143例患者平均随访(2.5±0.5)年。143例腰椎退行性变足下垂患者中有76例腰椎间盘突出症,责任节段均为L4~5,L5神经根受压。67例患者腰椎管狭窄,其中46例L4~5椎管狭窄,L5神经根受压;17例L4~5和L5S1椎管狭窄,L5和S1神经根受压;4例患者L3~4、L4~5和L5S1椎管狭窄,L4、L5和S1神经根均受压。术后81例(56.64%)TA的肌肉力量≥4级,获得治愈;62例(43.36%)患者TA的肌肉力量≤3级,虽然较术前有所改善,但未治愈,术后6个月随访,TA的肌肉力量几乎稳定。末次随访时分别有5、17、14、26、70、11例患者TA的肌肉力量是0、1、2、3、4、5级。结论腰椎退行性变引起足下垂的患者中,L5神经根常受影响。术后大多数患者TA的肌肉力量有所改善,但很少有患者足下垂可以完全恢复。术前足下垂症状持续时间、TA术前肌力、受累节段是影响患者手术效果的三个重要因素。

Objective To analyze the effect of degenerative lumbar spine disease after foot drop surgery.Methods We retrospectively analyzed the clinical characteristics,surgical treatment,and prognosis of 143 cases of degenerative lumbar spine in Beijing Shijitan Hospitalof Capital Medical University.The age,gender,duration of preoperative paralysis,and the strength of the tibialis anterior muscle TA before surgery were recorded and compared with the patient's postoperative condition.Results 143 patients were followed up for an average of(2.5±0.5)years.Among the 143 patients with lumbar degenerative foot drop,76 had lumbar disc herniation,the responsible segments were L4~5,and the L5 nerve root was compressed;67 patients were patients with lumbar spinal stenosis,of which 46 were L4~5 spinal stenosis,L5 nerve root compression,17 patients with L4~5 and L5S1 spinal stenosis,L5 and S1 nerve root compression,4 patients with L3~4,L4~5,and L5S1 spinal stenosis,and L4,L5 and S1 nerve root.After surgery,81 patients(56.64%)had TA muscle strength of≥4 and were cured,and 62 patients(43.36%)had TA muscle strength of≤3.Although the muscle strength of TA was improved before surgery,it was not cured,and the follow-up of 6 months after operation showed that the muscle strength of TA was almost stable.In the last follow-up,there were 5、17、14、26、70、11 patients with TA muscle strength of 0、1、2、3、4、5.Multivariate logistic regression showed that duration of paralysis,muscle strength before TA,and age were factors that affected postoperative recovery.Conclusion L5 nerve roots are most often affected in patients with dropfoot caused by degenerative lumbar spine.In most patients,the muscle strength of TA has improved after surgery,but few patients can completely recover from foot drop.The duration of paralysis is short,better pre-TA muscle strength and lesion segments are the three important factors affecting the effect of surgery.