神经根袖加固重建术治疗症状性骶管Tarlov囊肿71例临床分析

doi:10.19723/j.issn.1671-167X.2023.01.020

摘要/Abstract

摘要：

目的: 探讨神经根袖加固重建术治疗症状性骶管Tarlov囊肿的安全性及有效性。方法: 回顾性分析2018年6月至2021年3月因症状性骶管Tarlov囊肿，在北京大学第三医院神经外科行神经袖加固重建术的71例患者的临床资料及随访资料。手术均在神经电生理监测下进行，术中行囊肿探查、囊壁部分切除、漏口缩窄、神经根袖重建及人工硬膜加固。统计手术并发症、新发神经功能障碍的发生情况；采用疼痛视觉模拟评分(visual analogue scale，VAS)评估手术前后疼痛变化，采用日本骨科学会(Japanese Orthopedics Association，JOA)下腰痛评分评估手术前后神经功能变化及手术改善效果。结果: 71例患者共101个Tarlov囊肿，其中起源于左侧S1、S2、S3神经根者分别有19个(18.8%)、26个(25.7%)和3个(3.0%)，右侧S1、S2、S3神经根者分别有14个(13.9%)、33个(32.7%)和6个(5.9%)，均行神经根袖加固重建术。术后深部感染、皮下积液及切口脂肪液化各1例，泌尿系感染4例；随访12~43个月(中位数26个月)，新发尿潴留2例，分别于术后1个月、2个月拔除尿管；新发大便无力1例，3个月后好转；新发会阴部感觉异常5例，4例好转。与术前相比，末次随访时VAS显著降低[6(4~9)分vs. 1(0~5)分，Z=-7.272，P < 0.001]，JOA评分显著升高[20(16~25)分vs. 27(18~29)分，Z=-7.265，P < 0.001]。治愈18例(25.4%)，显效41例(57.7%)，有效8例(11.3%)，无效4例(5.6%)，总有效率94.4%(67/71)。2个(1.98%)囊肿复发。结论: 对于症状性骶管Tarlov囊肿患者行神经根袖重建及人工硬膜加固术，可显著改善患者疼痛及神经功能，且安全可靠。

关键词: Tarlov囊肿, 骶管, 整形外科手术, 神经根袖加固重建术

Abstract:

Objective: To investigate the safety and efficacy of reinforced radiculoplasty in the treatment of symptomatic sacral Tarlov cysts (TCs). Methods: A retrospective analysis was performed on the clinical data and follow-up data of 71 patients with symptomatic sacral TCs who underwent reinforced radiculoplasty in the Neurosurgery Department of Peking University Third Hospital from June 2018 to March 2021. All the operations were performed under neuroelectrophysiological monitoring. Intraoperative cyst exploration, partial resection of the cyst wall, narrowing of the leak, nerve root sleeve radiculoplasty and artificial dural reinforcement were performed. The incidence of postoperative complications and new neurological dysfunction was analyzed. Visual analogue scale (VAS) was used to assess the changes of pain before and after surgery. The Japanese Orthopedics Association (JOA) low back pain score was used to evaluate the changes in nerve function before and after surgery. Results: In the study, 71 patients had 101 TCs, 19 (18.8%) TCs originated from the left S1 nerve, 26 (25.7%) originated from the left S2 nerve, 3 (3.0%) originated from the left S3 nerve, 14 (13.9%) originated from the right S1 nerve, 33 (32.7%) originated from the right S2 nerve, 6 (5.9%) originated from the right S3 nerve, all the TCs underwent reinforced radiculoplasty. Deep infection (1 case), subcutaneous effusion (1 case), fat li-quefaction (1 case) and urinary tract infection (4 cases) were recorded postoperatively. The patients were followed up for 12-43 months (median, 26 months). Two cases had new urinary retention after operation, and the catheter was removed at the end of the first and second months respectively. One case had new fecal weakness, which improved after 3 months. Compared with preoperation, VAS decreased significantly at the last follow-up [median, 6 (4-9) vs. 1 (0-5), Z=-7.272, P < 0.001], JOA score increased significantly [median, 20 (16-25) vs. 27 (18-29), Z=-7.265, P < 0.001]. There were 18 cured cases (25.4%), 41 excellent cases (57.7%), 8 effective cases (11.3%), and 4 invalid cases (5.6%). The total efficiency was 94.4% (67/71). Two (1.98%) cysts recurred. Conclusion: For patients with symptomatic sacral TCs, reinforced radiculoplasty can significantly improve the pain and nerve function, which is safe and reliable.

Key words: Tarlov cysts, Sacral canal, Plastic surgery procedures, Reinforced radiculoplasty

中图分类号:

R651.2

吴超,刘彬,谢京城,王振宇,马长城,杨军,孙建军,陈晓东,于涛,林国中,司雨,韩芸峰,陈素华,尹晓亮,马千权,郑穆天,曾琳. 神经根袖加固重建术治疗症状性骶管Tarlov囊肿71例临床分析[J]. 北京大学学报（医学版）, 2023, 55(1): 133-138.

Chao WU,Bin LIU,Jing-cheng XIE,Zhen-yu WANG,Chang-cheng MA,Jun YANG,Jian-jun SUN,Xiao-dong CHEN,Tao YU,Guo-zhong LIN,Yu SI,Yun-feng HAN,Su-hua CHEN,Xiao-liang YIN,Qian-quan MA,Mu-tian ZHENG,Lin ZENG. Reinforced radiculoplasty for the treatment of symptomatic sacral Tarlov cysts: A clinical analysis of 71 cases[J]. Journal of Peking University (Health Sciences), 2023, 55(1): 133-138.

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