摘要
目的:探讨症状性腰椎管硬膜外脂肪增多症的诊断与手术治疗的临床疗效。方法:回顾性分析2012年2月至2018年11月进行压迫节段的半椎板切除椎间融合内固定术治疗的19例症状性腰椎管内硬膜外脂肪增多症患者的临床资料,其中男7例,女12例;年龄48~72(57.6±1.2)岁;病程6~60(18.6±5.1)个月;减压平面:L2,3-L5S1平面4例,L2,3-L4,5平面5例,L3,4-L4,5平面2例,L3,4-L5S1平面6例,L4,5-L5S1平面2例。分别于术前、术后6个月采用视觉模拟疼痛评分(visual analogue scale,VAS)评价腿疼和腰疼的缓解程度,采用Oswestry功能障碍指数评分(Oswestry Disability Index,ODI)评价功能恢复情况,并采用Fischgrund标准判定总体疗效。结果:所有患者获随访,随访时间12~37(16.3±3.8)个月。19例患者均顺利完成手术,椎管内压迫节段脂肪组织全部摘除。手术时间125~260(186±15)min,出血量150~500(280±46)ml。2例患者出现部分切口脂肪液化渗液不愈,经切口撑开去除积液后积极换药抗炎处理后愈合。所有患者无马尾神经损伤、脑脊液漏、钉棒断裂等并发症。术前腰痛、腿疼VAS评分分别为(5.3±0.7)、(6.8±0.8)分,术后6个月分别为(2.1±0.4)、(2.3±0.5)分,术后6个月与术前比较差异有统计学意义(P<0.05)。术后6个月ODI评分(12.1±2.3)分较术前(45.5±2.8)分明显改善(P<0.05)。根据Fischgrund标准,本组优13例,良4例,可2例。结论:症状性腰椎管硬膜外脂肪增多症患者进行压迫节段的半椎板切除椎间融合内固定手术,可解除硬脊膜及马尾神经的压迫,术后能取得较好的临床疗效。
Objective:To explore diagnosis and surgical treatment of symptomatic lumbar spinal epidural lipoplasia.Methods:A retrospective analysis of 19 patients with symptomatic lumbar spinal epidural hyperplasia treated with hemilaminectomy and interbody fusion and internal fixation from February 2012 to November 2018 were performed,including 7 males and 12 females,aged from 48 to 72 years old with an average of(57.6±1.2)years old;the course of disease ranged from 6 to 60 months with an average of(18.6±5.1)months;plane requiring decompression:L2,3-L5S1 on 4 cases,L2,3-L4,5 on 5 cases,L3,4-L4,5 on 2 cases,L3,4-L5S1 on 6 cases,L4,5-L5S1 on 2 cases.Visual analogue scale(VAS)before operation and 6 months after opertaion were used to evaluate relief of leg pain and back pain,Oswestry Disability Index(ODI)was used to evaluate recovery of functiona,and Fischgrund was used to assess overall efficacy.Results:All patients were followed up from 12 to 37 months with an average of(16.3±3.8)months.Ninteen patients were successfully completed operation,and all adipose tissues in the compressed segment of the spinal canal were removed.Operation time was from 125 to 260 min with an average of(186±15)min,and blood bleeding was from 150 to 500 ml with an average of(280±46)ml.Two patients occurred partial incision fat liquefaction and exudate did not heal,the incision was opened to remove effusion,the dressing was changed and anti-inflammatory treatments were performed.No complications such as cauda equina injury,cerebrospinal fluid leakage,and broken nails occurred.Preopertaive VAS of back pain and leg pain were 5.3±0.7 and 6.8±0.8,respectively,while 2.1±0.4 and 2.3±0.5 respectively at 6 months after opertaion,there were statistical significant difference between 6 months after operation and before operation(P<0.05).Postoperative ODI score at 6 months was 12.1±2.3,and significantly improved than that of before operation 45.5±2.8(P<0.05).According to Fischgrund criteria,13 patients got excellent result,4 good,and 2 fair.Conclusion
作者
顾仕荣
张明
陈斌辉
桑裴铭
方海名
GU Shi-rong;ZHANG Ming;CHEN Bin-hui;SANG Pei-ming;and FANG Hai-ming(Department of Orthopaedics,Ningbo Medical Treatment Centre Li Huili Hospital,Ningbo 315000,Zhejiang,China)
出处
《中国骨伤》
CAS
CSCD
2021年第5期458-461,共4页
China Journal of Orthopaedics and Traumatology
关键词
椎管
硬膜
骨折固定术
内
Spinal canal
Dura mater
Fracture fixation,internal
