【摘要】 [目的]比较伴与不伴马尾神经冗余征(redundant nerve roots, RNRs)腰椎管狭窄症患者的手术疗效。[方法] 2015年1月～2016年11月本院收治的腰椎管狭窄症患者294例,男138例,女156例,年龄41～83岁,平均(59.36±8.84岁),行仰卧位MRI检查,按矢状位椎管内马尾神经是否冗余分为RNRs阳性组和RNRs阴性组,观察手术时间、术中失血量、术后引流量及手术前、后腰部VAS、腿部VAS和ODI评分,评估其手术疗效。[结果] 294例腰椎管狭窄症患者,其中RNRs阳性102例,RNRs阴性192例。两组患者术前一般资料比较差异无统计学意义(P>0.05)。RNRs阳性组患者在手术时间、术中失血量、术后引流量上均明显高于RNRs阴性组,差异有统计学意义(P<0.05)。术后随访12～27个月,平均(14.35±2.87)个月,两组患者术后VAS和ODI评分均较术前显著下降,差异有统计学意义(P>0.05)。RNRs阳性组患者术后7d及末次随访腿部VAS评分均高于RNRs阴性组患者,差异有统计学意义(P<0.05);RNRs阳性组术后7 d及末次随访ODI评分,亦均高于RNRs阴性组患者,差异有统计学意义(P<0.05)。随访期间均未发现严重并发症。[结论]伴马尾神经冗余征较不伴有该征者术后恢复较差,临床上应予以重视。更多还原

【Abstract】 [Objective] To compare the surgical outcome of lumbar spinal stenosis with or without redundant nerve roots(RNRs). [Method] A total of 294 patients with lumbar spinal stenosis were surgically treated in our hospital from January 2015 to November 2016. The 294 patients,including 138 males and 156 females, aged from 41 to 83 years with a mean of(59.36±8.84) years. In the supine position, MRI examination was performed to observe the cauda equina in the sagittal vertebral canal.According to whether or not RNRs were found on MRI, the patients were divided into positive RNRs group and negative RNRs group. The operative time, intraoperative blood loss, postoperative drainage, lumbar and leg VAS, as well as ODI scores were compared between the two groups. [Result] Among the 294 patients with lumbar spinal stenosis, 102 patients were proved positive RNRs, while 192 patients were negative RNR. There were no significant differences regarding to the general data preoperatively between the two groups(P>0.05). However, the positive group proved significantly greater than the negative group in operative time, intraoperative blood loss and postoperative drainage volume(P<0.05). All the patients were followed up from12 to27 months, with an average of(14.35±2.87) months. Compared with those before operation, the VAS and ODI scores in both groups significantly decreased postoperatively(P<0.05). The positive group was marked significantly higher leg VAS and ODI scores than the negative group at each corresponding time point postoperatively, including 7 days after operation and the latest follow up(P<0.05), despite no significant differences between them preoperatively(P>0.05). During the follow up, no serious complications were noticed in any patients of them. [Conclusion] The patients with lumbar spinal stenosis accompanied by redundant nerve roots achieve inferior operative outcomes to those without redundant nerve roots, which should be paid attention in clinical settings.更多还原