腰大池引流联合生物蛋白胶黏贴肌瓣治疗骶管囊肿的疗效分析

Analysis of the therapeutic efficacy of lumbar cistern drainage combined with pedicled muscle flap using fibrin glue in the treatment of sacral canal cysts

目的探讨腰大池引流联合生物蛋白胶黏贴肌瓣治疗骶管囊肿的疗效分析.方法回顾性分析2018年1月至2023年6月收治的82例症状性骶管囊肿患者的资料,均行腰大池引流联合生物蛋白胶黏贴肌瓣治疗骶管囊肿.结果所有患者均顺利完成手术并完成随访,随访时间6-14个月,平均10个月.采用日本骨科学会(JOA)和疼痛视觉模拟评分(VAS)评估患者术后3、6个月的神经功能改善情况,JOA评分术前(16.09±1.91)分,术后升至(23.09±1.77)分,差异具有统计学意义(t=-40.75,P<0.05).VAS评分术前(5.52±1.28)分,术后降至(2.22±0.83)分,差异有统计学意义(t=31.023,P<0.05).疼痛消失38例(46.34%),改善36例(43.90%),无变化5例(6.10%);感觉障碍消失19例(23.17%),改善26例(31.71%),无变化6例(7.32%);下肢无力消失2例(2.44%),改善5例(6.10%),无变化2例(2.44%);排便障碍消失6例(7.32%),改善15例(18.29%),无变化4例(4.88%);排尿障碍消失6例(7.32%),改善13例(15.85%),无变化4例(4.88%);性功能障碍消失0例(0.00%),改善2例(2.44%),无变化3例(3.66%).结论腰大池引流联合生物蛋白胶黏贴肌瓣是治疗骶管囊肿有效、复发率低、并发症少的治疗方式.

Objective To explore the therapeutic efficacy of lumbar cistern drainage combined with biologic fibrin glue and muscle flap application in the treatment of sacral meningeal cysts.Methods A retrospective analysis was conducted of data from 82 patients with symptomatic sacral meningeal cysts admitted between January 2018 and June 2023,all of whom underwent lumbar cistern drainage combined with biologic fibrin glue and muscle flap treatment for sacral meningeal cysts.Results All of the 82 patients successfully underwent the surgery and follow-up,with a follow-up period ranging from 6 to 14 months(average 10 months).The Japanese Orthopedics Association(JOA)and Visual Analogue Scale(VAS)were used to evaluate the neurofunctional improvement after the third and sixth months postoperatively.The JOA score increased from 16.09±1.91 preoperatively to 23.09±1.77 postoperatively,showing a statistically significant difference(t=-40.75,P<0.05),whereas the VAS score decreased from 5.52±1.28 preoperatively to 2.22±0.83 postoperatively,with a statistically significant difference(t=31.023,P<0.05).Pain disappearance was observed in 38 cases(46.34%),improvement in 36 cases(43.90%),and no change in 5 cases(6.09%).Sensory disturbances disappeared in 19 cases(23.17%),improved in 26 cases(31.70%),and showed no change in 6 cases(7.32%).Lower limb weakness disappeared in 2 cases(2.44%),improved in 5 cases(6.09%),and showed no change in 2 cases(2.44%).Bowel dysfunction disappeared in 6 cases(7.32%),improved in 15 cases(18.29%),and showed no change in 4 cases(4.88%).Urinary dysfunction disappeared in 6 cases(7.32%),improved in 13 cases,and showed no change in 4 cases(4.88%).Sexual dysfunction showed no disappearance(0.00%),improvement in 2 cases(2.44%),and no change in 3 cases(3.66%).Conclusion Lumbar cistern drainage combined with biologic fibrin glue and muscle flap application is an effective,low recurrence rate,and complication-minimized treatment for sacral meningeal cysts.