经椎间孔内镜下椎间盘切除术治疗腰椎间盘突出症合并腓总神经麻痹的临床效果分析：32例患者的2年随访回顾性研究
Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients.
作者信息
Wang Ya-Peng, Zhang Wei, Zhang Jian, Sun Ya-Peng, An Ji-Long, Ding Wen-Yuan
机构信息
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
出版信息
J Pain Res. 2017 Jan 5;10:105-112. doi: 10.2147/JPR.S120463. eCollection 2017.
BACKGROUND
Very few studies have discussed transforaminal endoscopic discectomy (TED) in the treatment of common peroneal nerve paralysis induced by lumbar disk herniation (LDH). This study aimed to evaluate the efficacy of TED in the treatment of LDH combined with common peroneal nerve paralysis.
MATERIALS AND METHODS
The clinical and follow-up data of 32 patients with common peroneal nerve paralysis induced by LDH undergoing TED from March 2011 to April 2014 were retrospectively analyzed in this study. Follow-up was conducted immediately after the surgery, as well as 3, 12, and 24 months postoperatively. The parameters (including muscle strength recovery of the anterior tibial muscle, leg pain visual analog scale score, neurological function Japanese Orthopaedic Association [JOA] score, MacNab scores in the last follow-up, and the intraoperative and postoperative complications) were recorded.
RESULTS
Three patients (9.4%) had the anterior tibial muscle strength recovered to ≥ grade 4 immediately after the surgery. The anterior tibial muscle strength of patients recovered to basically stable form in the 6-month postoperative follow-up and that in the last follow-up were as follows: one case of grade 1, one case of grade 2, 28 cases of grade 4, and two cases of grade 5. The visual analog scale scores of leg pain were significantly reduced immediately after the surgery and also on 3, 12, and 24 months compared with preoperative period (all <0.05). The postoperative JOA scores in the last follow-up were significantly higher than the preoperative JOA scores (<0.05), and there were nine excellent cases (28.2%), 21 good cases (65.6%), one fair case (3.1%) and one poor case (3.1%) in the last follow-up, with an overall excellent and good rate of 93.8%.
CONCLUSION
TED, which can offer sufficient decompression of the nerve root, has excellent overall clinical effects in treating common peroneal nerve paralysis induced by LDH.
背景
很少有研究探讨经椎间孔内镜下椎间盘切除术（TED）治疗腰椎间盘突出症（LDH）所致腓总神经麻痹。本研究旨在评估TED治疗LDH合并腓总神经麻痹的疗效。
材料与方法
回顾性分析2011年3月至2014年4月行TED治疗的32例LDH所致腓总神经麻痹患者的临床及随访资料。术后即刻、术后3个月、12个月和24个月进行随访。记录相关参数（包括胫前肌肌力恢复情况、腿痛视觉模拟评分、神经功能日本骨科学会[JOA]评分、末次随访时的MacNab评分以及术中及术后并发症）。
结果
3例患者（9.4%）术后即刻胫前肌肌力恢复至≥4级。患者胫前肌肌力在术后6个月随访时基本恢复稳定，末次随访时情况如下：1例1级，1例2级，28例4级，2例5级。术后即刻及术后3个月、12个月和24个月时腿痛视觉模拟评分均较术前显著降低（均<0.05）。末次随访时术后JOA评分显著高于术前JOA评分（<0.05），末次随访时有9例优（28.2%），21例良（65.6%），1例可（3.1%），1例差（3.1%），优良率总体为93.8%。
结论
TED能充分减压神经根，治疗LDH所致腓总神经麻痹临床总体效果优良。
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