术前增强3D SPACE STIR序列在减少L<sub>4~5</sub>极外侧椎间融合术后股神经损伤中的研究

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摘要目的探讨术前增强3D SPACE STIR序列检查在减少L_4~5极外侧椎间融合术(extreme lateral interbody fusion，XLIF)术后股神经损伤中的作用。方法回顾分析2017年9月至2019年2月采用XLIF治疗37例L_4~5节段退行性疾病患者。传统组17例，男9例，女8例；年龄41~82岁，平均(63.3±12.7)岁；术前行传统MRI检查确认责任节段，术中采用椎间隙中点(Ⅱ~Ⅲ区交界处)处进行穿刺入路。改良组20例，男13例，女7例；年龄48~85岁，平均(65.4±12.3)岁；术前先行增强3D SPACE STIR序列检查，个体化选择穿刺点进行穿刺入路。统计改良组穿刺点分布情况，两组术后即刻、3个月、6个月、1年股神经损伤例数，术前及术后3个月、6个月、1年疼痛视觉模拟评分(visual analogue scale，VAS)及Oswestry功能障碍指数(oswestry disability index，ODI)。结果传统组17例患者选择Ⅱ~Ⅲ区交界处作为穿刺点；改良组20例患者中，穿刺位置选择Ⅰ区内1例，Ⅰ~Ⅱ区交界处13例，Ⅱ~Ⅲ区交界处6例。所有患者术后均获得随访，随访时间1年。随着时间推移，术后VAS及ODI均较术前明显改善，两组患者都未出现融合器下沉、移位、血管损伤、输尿管损伤的并发症。改良组术后即刻股前区麻木、下肢运动障碍例数均小于传统组(P＜0.05)。结论根据增强3D SPACE STIR序列检查制定个体化XLIF可减少XLIF术后股神经损伤。

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	文浩辉
	杨大志
	易伟宏 *

关键词 ： 3D SPACE STIR, 极外侧椎间融合术, 股神经

Abstract：Objective To investigate the effects of enhanced 3D SPACE STIR sequence for reducing L_4~5 extreme lateral interbody fusion(XLIF) the effect of postoperative femoral nerve injury.Methods From September 2017 to February 2019，37 cases of L_4~5 degenerative diseases were treated with XLIF.In traditional group，there were 17 cases，including 9 males and 8 females.The age ranged from 41 to 82 years，with a mean of (63.3±12.7)years.Preoperative traditional MRI examination was performed to identify the responsible segment，and intraoperative puncture approach was performed at the midpoint of the intervertebral space (the junction of zone Ⅱ~Ⅲ).In the modified group，there were 20 cases，including 13 males and 7 females.The age ranged from 48 to 85 years，with an average of (65.4±12.3)years.Enhanced 3D SPACE STIR examination was performed preoperative，and puncture sites were individually selected for puncture approach.Weanalyzed the distribution of puncture points in the modified group，the number of femoral nerve injury cases，visual analog scale(VAS) and Oswestry disability index(ODI) in the two groups at immediate postoperative，postoperative 3 months，6 months and 1 year.Results In the traditional group，17 patients chose the junction of Ⅱ~Ⅲ as the puncture point，while in the improved group，1 case was located in zone Ⅰ，13 cases at the junction of Ⅰ~Ⅱ and 6 cases at the junction of Ⅱ~Ⅲ.All patients were followed up for 1 year after surgery.As time went on，VAS and ODI were significantly improved postoperative compared with preoperative，and there were no complications，such as cage subsident，shifting，vascular injury or ureter injury in both groups.In modified group，the number of numbness in anterior femoral and lower limbsweakness immediately postoperative was lower than traditional group(P＜0.05).Conclusion Individualized XLIF according to enhanced 3D SPACE STIR examination can reduce femoral nerve injury after XLIF.

Key words： 3D SPACE STIR extreme lateral interbody and fusion femoral nerve

通讯作者: 易伟宏

作者简介: 文浩辉(1994－ )，男，医师，华中科技大学协和深圳医院脊柱外科，518052。

引用本文:

文浩辉，杨大志，易伟宏 *. 术前增强3D SPACE STIR序列在减少L_4~5极外侧椎间融合术后股神经损伤中的研究[J]. 实用骨科杂志, 2021, 27(11): 975-979.
Wen Haohui，Yang Dazhi，Yi Weihong *. Study of Preoperative Enhanced 3D SPACE STIR Sequence in Reducing Femoral Nerve Injury After L_4~5 Exreme Lateral Interbody and Fusion. sygkzz, 2021, 27(11): 975-979.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I11/975

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