腰4/5椎管狭窄单侧症状患者MIS-TLIF术后解剖数据的改变研究

Changes of Anatomic Data After MIS-TLIF in Patients with Unilateral Symptoms of Lumbar 4/5 Spinal Stenosis

目的探讨L4/5节段椎管狭窄患者接受腰椎后路减压微创通道下经椎间孔腰椎椎体融合术(MIS-TLIF)术后神经根管在不同CT层面中面积的改变情况。方法选取2020年6月至2021年6月在我院确诊并进行治疗的单侧L4/5节段椎管狭窄患者23例为研究对象,记录术中出血量、手术时间,术后并发症发生情况。观察椎管狭窄患者MIS-TLIF术前、术后VAS评分、ODI评分变化,并测量手术前、后的CT,比较不同高度位置椎管、神经根管和L4/5,L5/S1椎间孔等的面积变化。结果所有患者手术过程顺利,手术(125.67±32.53)min;术中平均出血(183.67±76.27)ml,输血7例。术后出现脑脊液漏2例,经卧床、补液等治疗后治愈。感染0例,术后贫血8例,深静脉血栓4例。其余未见感染、肺栓塞等并发症出现,无死亡病例。A段神经根管面积由术前(26.94±5.15)mm^(2),增加至(113.11±12.02)mm^(2)(P<0.001);B段神经根管面积由术前的(42.29±6.53)mm^(2),增加至(59.21±9.95)mm^(2),(P=0.019);C段神经根管面积由术前的(69.12±8.45)mm^(2),增加至(72.55±9.88)mm^(2)(P=0.594);L4/5椎间孔面积由术前(72.94±8.46)mm^(2),增加至(103.55±14.84)mm^(2)(P=0.023);L5/S1椎间孔面积由术前(97.02±10.67)mm^(2),增加至(109.73.07±13.50)mm^(2),(P=0.120)。临床评分上,术前腿疼VAS评分7.04±1.33,腰痛VAS评分(2.83±0.89);术后2周时,腿疼评分(3.79±0.76),腰痛评分(5.75±0.79);术后1个月时,腿疼评分(3.17±0.75),腰痛评分(3.94±0.85);术后3个月时,腿疼评分(2.96±0.68),腰痛评分(2.68±0.49);术后6个月时,腿疼评分(2.71±0.81),腰痛评分(2.37±0.56);术后12月时,腿疼评分(2.08±0.81),腰痛评分(2.20±0.58)。术前患者ODI评分(54.79±10.73);术后3月为(42.41±8.39);术后6月为(32.08±6.35);术后12月为(20.83±7.01)。结论腰椎椎管狭窄症患者行MIS-TLIF手术后较术前相比,患者症状均显著改善,L4/5椎间孔面积、神经根管A段、B段面积显著增大。L5/S1椎间孔面积及神经根管C段面积虽然增大,但差异无统计学意义。

Objective To investigate the changes of nerve root canal area in different CT levels in patients with L4/5 spinal stenosis who underwent lumbar posterior decompression and minimally invasive transforaminal lumbar body fusion(MIS-TLIF).Methods A total of 23 patients with unilateral L4/5 spinal stenosis diagnosed and treated in our hospital from June 2020 to June 2021 were selected.Intraoperative blood loss,operation time and postoperative complications were recorded.VAS score and ODI score of patients with spinal stenosis were assessed,and CT before and after surgery were measured to compare the area changes of nerve root canal,L4/5,L5/S1 foramina at different heights.Results All patients underwent smooth operation,at an average time of(125.67±32.53)min;The average intraoperative bleeding was(183.67±76.27)ml,and 7 cases were transfused.Cerebrospinal fluid leakage occurred in 2 cases after operation,and was cured after bed rest and fluid replenishment.There was 0 case of infection,8 cases of postoperative anemia and 4 cases of deep vein thrombosis.Other complications such as infection and pulmonary embolism were not observed,and there was no death case.The area of nerve root canal in segment A increased from(26.94±5.15)mm^(2)to(113.11±12.02)mm^(2)(P<0.001).The area of nerve root canal in segment B increased from(42.29±6.53)mm^(2)to(59.21±9.95)mm^(2)(P=0.019).The area of nerve root canal in segment C increased from(69.12±8.45)mm^(2)to(72.55±9.88)mm^(2)(P=0.594).The area of L4/5 foramen increased from(72.94±8.46)mm^(2)to(103.55±14.84)mm^(2)(P=0.023).The area of the L5/S1 foraminal increased from(97.02±10.67)mm^(2)to(109.73.07±13.50)mm^(2)(P=0.120).Preoperative VAS scores were(7.04±1.33)for leg and(2.83±0.89)for waist.Two weeks after surgery,the score of leg pain was(3.79±0.76),and(5.75±0.79)for lumbago.1 month after surgery,the score of leg pain was(3.17±0.75),and(3.94±0.85)for lumbago.Three months after surgery,the score of leg pain was(2.96±0.68),and(2.68±0.49)for lumbago.after 6 months,the score of leg pain was(2.71±0.81),and(2.37±0.56)for lumbago.12 months after surgery,the score of leg pain was(2.08±0.81),and(2.20±0.58)for waist.Preoperative ODI score(54.79±10.73),and(42.41±8.39)at 3 months after operation,(32.08±6.35)for 6 months,(20.83±7.01)for 12 months after operation.Conclusion After MIS-TLIF surgery,the symptoms of patients with lumbar spinal stenosis are significantly improved,and the area of the L4/5 intervertebral foramen and the A and B segments of the nerve root canal significantly increase.Although the area of the L5/S1 foraminal and the area of the C segment of the nerve root canal increase,there is no significant difference.