[强化神经根成形术治疗有症状的骶部塔尔洛夫囊肿：71例临床分析]
[Reinforced radiculoplasty for the treatment of symptomatic sacral Tarlov cysts: A clinical analysis of 71 cases].
作者信息
Wu C, Liu B, Xie J C, Wang Z Y, Ma C C, Yang J, Sun J J, Chen X D, Yu T, Lin G Z, Si Y, Han Y F, Chen S H, Yin X L, Ma Q Q, Zheng M T, Zeng L
机构信息
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China.
Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Feb 18;55(1):133-138. doi: 10.19723/j.issn.1671-167X.2023.01.020.
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) . 1 (0-5), =-7.272, < 0.001], JOA score increased significantly [median, 20 (16-25) . 27 (18-29), =-7.265, < 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.
目的
探讨强化神经根成形术治疗有症状的骶部塔尔洛夫囊肿（TCs）的安全性和有效性。
方法
回顾性分析2018年6月至2021年3月在北京大学第三医院神经外科接受强化神经根成形术的71例有症状的骶部TCs患者的临床资料和随访资料。所有手术均在神经电生理监测下进行。术中进行囊肿探查、囊肿壁部分切除、漏口缩小、神经根袖神经根成形术和人工硬膜强化。分析术后并发症和新的神经功能障碍的发生率。采用视觉模拟评分法（VAS）评估手术前后疼痛的变化。采用日本骨科学会（JOA）下腰痛评分评估手术前后神经功能的变化。
结果
本研究中，71例患者有101个TCs，19个（18.8%）TCs起源于左侧S1神经，26个（25.7%）起源于左侧S2神经，3个（3.0%）起源于左侧S3神经，14个（13.9%）起源于右侧S1神经，33个（32.7%）起源于右侧S2神经，6个（5.9%）起源于右侧S3神经，所有TCs均接受了强化神经根成形术。术后记录深部感染（1例）、皮下积液（1例）、脂肪液化（1例）和尿路感染（4例）。患者随访12 - 43个月（中位时间26个月）。2例术后出现新的尿潴留，分别在第1个月和第2个月末拔除导尿管。1例出现新的排便无力，3个月后好转。与术前相比，末次随访时VAS显著降低[中位数，6（4 - 9）. 1（0 - 5），=-7.272，<0.001]，JOA评分显著升高[中位数，20（16 - 25）. 27（18 - 29），=-7.265，<0.001]。治愈18例（25.4%），优41例（57.7%），有效8例（11.3%），无效4例（5.6%）。总有效率为94.4%（67/71）。2个（1.98%）囊肿复发。
结论
对于有症状的骶部TCs患者，强化神经根成形术可显著改善疼痛和神经功能，安全可靠。
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