| 腰椎术后碎骨块神经压迫症的诊疗及原因分析 |
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Received:June 19, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 顾仕荣 |
GU Shi-rong |
宁波市医疗中心李惠利医院骨2科, 浙江 宁波 315000 |
The Second Department of Orthopaedics, Lihuili Hospital of Ningbo Medical Center, Ningbo 315000, Zhejiang, China |
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| 张明 |
ZHANG Ming |
宁波市医疗中心李惠利医院骨2科, 浙江 宁波 315000 |
The Second Department of Orthopaedics, Lihuili Hospital of Ningbo Medical Center, Ningbo 315000, Zhejiang, China |
zmwxh@163.com |
| 陈斌辉 |
CHEN Bin-hui |
宁波市医疗中心李惠利医院骨2科, 浙江 宁波 315000 |
The Second Department of Orthopaedics, Lihuili Hospital of Ningbo Medical Center, Ningbo 315000, Zhejiang, China |
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| 桑裴铭 |
SANG Pei-ming |
宁波市医疗中心李惠利医院骨2科, 浙江 宁波 315000 |
The Second Department of Orthopaedics, Lihuili Hospital of Ningbo Medical Center, Ningbo 315000, Zhejiang, China |
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| 方海名 |
FANG Hai-ming |
宁波市医疗中心李惠利医院骨2科, 浙江 宁波 315000 |
The Second Department of Orthopaedics, Lihuili Hospital of Ningbo Medical Center, Ningbo 315000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2021年34卷，第4期，第349-353页 |
| DOI：10.12200/j.issn.1003-0034.2021.04.011 |
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目的： 探讨腰椎术后碎骨块神经压迫症的诊疗、原因及预防。
方法： 对2012年2月至2019年3月收治的23例腰椎术后碎骨块神经压迫症患者进行回顾性分析，男9例，女14例，年龄42~81（62.60±5.70）岁。手术方式：腰椎椎间融合术20例，脊柱内镜术3例。23例患者术后均出现减压侧或对侧肢体的放射性疼痛，发生时间为术后即刻至术后2周，平均（3.2±1.7） d。所有患者术后复查腰椎CT或MRI证实残留异位碎骨块，同时双下肢血管彩超排除血栓形成。异位碎骨块来源：椎间融合植骨块脱落或开窗融合产生的碎骨块残留14例，断裂的上关节突头部6例，脊柱内镜手术上关节突成形骨块残留3例。
结果： 患者住院时间10~37（23.4±6.2） d。所有患者获得随访，时间6~25（13.6±3.4）个月。3例患者术后当天或第2天行后路开放神经根探查碎骨块取出术，术后疼痛症状缓解。20例患者先行保守治疗，13例患者保守治疗后，疼痛症状缓解后出院。7例患者保守治疗失败，其中2例保守失败患者期间做过神经根阻滞术。2例患者行脊柱内镜下神经根探查骨块取出术，5例患者行后路开放神经根探查碎骨块取出术，术后疼痛症状皆缓解。术前CT、MRI及术中碎骨块取出骨块形态及位置证实，碎骨块最大可能来源椎间融合植骨块脱落或开窗融合产生的碎骨块残留（14例），断裂的上关节突头部（6例），脊柱内镜手术上关节突成形骨块残留（3例）。末次随访根据Macnab标准评价疗效，结果优20例，良3例。
结论： 腰椎术后碎骨块神经压迫症采取合适的治疗手段处理，可获得较好的临床效果，术中及时取出可能造成残留的碎骨块，关闭切口前仔细探查神经根，可避免此类并发症。 |
| [关键词]:腰椎 碎骨块 手术后并发症 临床方案 |
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| Diagnosis, treatment and etiology analysis of nerve compression by bone fragment after lumbar spine surgery |
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Abstract:
Objective: To explore the diagnosis,treatment,cause and prevention of nerve compression by bone fragment after lumbar spine surgery.
Methods: The clinical data of 23 patients with nerve compression by bone fragment after lumbar spine surgery from February 2012 to March 2019 were collected retrospectively,including 9 males and 14 females,aged 42 to 81 years with an average of (62.60±5.70) years. The surgical methods included lumbar interbody fusion in 20 cases and spinalendoscopy in 3 cases. All 23 patients experienced radiating pain on the decompression side or the contralateral limb after operation. The time of occurrence was from immediately after operation to 2 weeks after operation,with an average of(3.2±1.7) days. All patients underwent postoperative examination of lumbar spine CT or MRI to confirm residual ectopic bone fragments,and at the same time,bilateral lower extremity color Doppler ultrasound excluded thrombosis. Sources of ectopic bone fragments:14 cases of residual bone fragments caused by intervertebral fusion bone graft loss or fenestration fusion,6 cases of fractured upper articular process head,and 3 cases of upper articular process bone remaining during spinal endoscopic surgery.
Results: The patient's hospital stay was 10 to 37 (23.4±6.2) days. All patients were followed up for 6 to 25 (13.6±3.4) months. Three patients underwent posterior open nerve root exploration for removing bone fragments on the same day or the second day after surgery,and the symptoms were relieved. Twenty patients underwent conservative treatment firstly,and 13 patients were discharged after pain relieved by conservative treatment,7 patients failed conservative treatment,the 2 cases of failed 7 cases had undergone nerve root block surgery during conservative treatment. Two patients underwent spinal endoscopy nerve root exploration and bone mass removal,and five patients underwent posterior open nerve root exploration and bone fragmentation removal. All postoperative pain symptoms were relieved. Preoperative CT,MRI and intraoperative bone fragment removal confirmed the shape and location of the bone fragments. The most likely source of bone fragments was the loss of intervertebral fusion bone grafts or residual bone fragments resulting from fenestration fusion (14 cases),fractured upper articular process head (6 cases),and upper articular process bones remaining in endoscopic surgery (3 cases). According to the Macnab criteria in evaluating clinical outcome,20 cases got excellent results and 3 good.
Conclusion: After the lumbar spine surgery,the nerve compression by bone fragments is treated with appropriate treatments,and good clinical results can be obtained. Timely removal of residual bone fragments during operation and careful exploration of nerve roots before closing incision can avoid such complications |
| KEYWORDS:Lumbar vertebrae Bone fragmentation Postoperative complications Clinical protocols |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 顾仕荣,张明,陈斌辉,桑裴铭,方海名.腰椎术后碎骨块神经压迫症的诊疗及原因分析[J].中国骨伤,2021,34(4):349~353 |
| 英文格式: | GU Shi-rong,ZHANG Ming,CHEN Bin-hui,SANG Pei-ming,FANG Hai-ming.Diagnosis, treatment and etiology analysis of nerve compression by bone fragment after lumbar spine surgery[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(4):349~353 |
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