|
|
腰椎间盘突出症术后残余症状的诊疗策略与进展
|
Abstract:
腰椎间盘突出症(Lumbar Disc Herniation, LDH)术后残余症状是一个常见但复杂的临床问题，严重影响患者术后生活质量。本文综述了LDH术后残余症状的流行病学、病因、临床表现、诊断和治疗等方面的研究进展。研究表明，LDH术后残余症状发生率高，主要与神经根压迫、炎症反应等因素有关。准确诊断需综合分析临床表现、影像学和电生理检查结果。治疗策略包括药物、物理疗法、微创手术和康复训练等，应遵循个体化原则。多模式疼痛管理有助于改善预后。未来研究应关注新型微创术式、治疗新方法以及个体化诊疗策略的制定，重视前瞻性、大样本临床试验和新技术应用，需要多学科协作，以期进一步提升LDH术后患者生活质量。
Postoperative residual symptoms of lumbar disc herniation (LDH) are a common yet complex clinical issue that significantly affects patients’ quality of life after surgery. This review summarizes the current research progress on the epidemiology, etiology, clinical manifestations, diagnosis, and treatment of postoperative residual symptoms of LDH. Studies show that the incidence of these residual symptoms is high and is primarily associated with factors such as nerve root compression and inflammatory responses. Accurate diagnosis requires a comprehensive analysis of clinical manifestations, imaging, and electrophysiological examination results. Treatment strategies include medication, physical therapy, minimally invasive surgery, and rehabilitation training, with an emphasis on individualized approaches. Multimodal pain management is beneficial for improving prognosis. Future research should focus on new minimally invasive techniques, novel treatment methods, and the development of individualized diagnostic and therapeutic strategies. Attention should be given to prospective, large-scale clinical trials and the application of new technologies, with a multidisciplinary approach to further enhance the quality of life of patients following LDH surgery.
| [1] | Benzakour, T., Igoumenou, V., Mavrogenis, A.F. and Benzakour, A. (2018) Current Concepts for Lumbar Disc Herniation. International Orthopaedics, 43, 841-851. https://doi.org/10.1007/s00264-018-4247-6 |
| [2] | Huang, W., Han, Z., Liu, J., Yu, L. and Yu, X. (2016) Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine (Baltimore), 95, e2378. https://doi.org/10.1097/md.0000000000002378 |
| [3] | Machado, G.C., Witzleb, A.J., Fritsch, C., Maher, C.G., Ferreira, P.H. and Ferreira, M.L. (2016) Patients with Sciatica Still Experience Pain and Disability 5 Years after Surgery: A Systematic Review with Meta‐Analysis of Cohort Studies. European Journal of Pain, 20, 1700-1709. https://doi.org/10.1002/ejp.893 |
| [4] | Shriver, M.F., Xie, J.J., Tye, E.Y., Rosenbaum, B.P., Kshettry, V.R., Benzel, E.C., et al. (2015) Lumbar Microdiscectomy Complication Rates: A Systematic Review and Meta-Analysis. Neurosurgical Focus, 39, E6. https://doi.org/10.3171/2015.7.focus15281 |
| [5] | Kim, L.H., Kim, H.S., Kim, S.W., et al. (2020) Prevalence of Neuropathic Pain after Lumbar Disc Herniation Surgery: A Prospective, Consecutive Study. Acta Neurochirurgica (Wien), 162, 351-358. |
| [6] | Wang, H., Li, S., Peng, Z., et al. (2020) Predictive Factors for Persistent Low Back Pain after Lumbar Disc Herniation Surgery. Journal of Clinical Neuroscience, 75, 76-80. |
| [7] | Haugen, A.J., Brox, J.I., Grøvle, L., Keller, A., Natvig, B., Soldal, D., et al. (2012) Prognostic Factors for Non-Success in Patients with Sciatica and Disc Herniation. BMC Musculoskeletal Disorders, 13, Article No. 183. https://doi.org/10.1186/1471-2474-13-183 |
| [8] | Lv, Z., Jin, L., Wang, K., et al. (2019) Incidence and Risk Factors of Residual Back Pain after Instrumented Posterior Lumbar Interbody Fusion for Lumbar Disc Herniation: A Large-Sample Retrospective Study with 2-Year Follow-Up. Pain Physician, 22, E627-E638. |
| [9] | Fan, G., Zhang, J.X., Wu, X.H., et al. (2020) Residual Leg Pain after Lumbar Discectomy: Prevalence and Risk Factors. Pain Physician, 23, 321-330. |
| [10] | Bai, X., Wen, T., Zhu, J., et al. (2022) Recurrent Lumbar Disc Herniation: A Review of Current Treatments and Research Update. Frontiers in Surgery, 9, Article ID: 821581. |
| [11] | Kim, D.H., Kim, S.Y., Shin, D.A., et al. (2022) Clinical Significance of Residual Symptoms in Patients with Lumbar Disc Herniation Following Posterior Decompression and Discectomy. Journal of Korean Neurosurgical Society, 65, 250-258. |
| [12] | Papavero, L., Marques, C.J., Lohmann, J., et al. (2021) Lumbosacral Transitional Vertebra and Lumbar Disc Herniation: What Role Do They Play in Surgical Outcome? European Spine Journal, 30, 402-408. |
| [13] | 吕建亮, 卢怀恩, 曹晓农, 等. 椎间孔镜治疗腰椎间盘突出症的中期疗效及影响因素分析[J]. 中华骨科杂志, 2019, 39(8): 484-489. |
| [14] | Son, S., Lee, S.G., Kim, W.K., et al. (2022) Outcomes of Repeated Lumbar Microdiscectomy for Recurrent Lumbar Disc Herniation: A Comparative Study on 100 Patients with a Minimum of Two-Years Follow-Up. Acta Neurochirurgica (Wien), 164, 135-143. |
| [15] | 张峰, 黄永红, 周洪波. 中药熏洗联合针刺治疗腰椎间盘突出症术后残余症状的疗效观察[J]. 针灸临床杂志, 2022, 38(4): 54-57. |
| [16] | 徐刚, 王瑛, 许飞, 等. 甲钴胺治疗腰椎间盘突出症的Meta分析[J]. 中国临床药理学杂志, 2020, 36(15): 1854-1859. |
| [17] | 杨阳, 黄华超, 庞爱华, 等. 髂腰肌及多裂肌表面肌电图在腰椎间盘突出症术后康复中的应用研究进展[J]. 中国康复医学杂志, 2020, 35(12): 1515-1520. |
| [18] | 周雯雯, 钱小燕, 蔡一鸣. 基于“通则不痛”理论的腰椎间盘突出症术后残余症状的中医药治疗进展[J]. 浙江中医杂志, 2022, 57(5): 387-390. |
| [19] | 李刚, 王旭升, 王向阳, 等. 腰椎间盘突出症术后腰腿痛残留原因及处理策略[J]. 中国脊柱脊髓杂志, 2020, 30(8): 750-754. |
| [20] | 梅杰, 张猛, 郑培永, 等. 腰椎间盘突出症术后残余下肢症状的原因分析及处理策略[J]. 中国脊柱脊髓杂志, 2021, 31(3): 259-262. |
| [21] | Wang, K., Zhu, Z., Wang, B., Zhu, Y. and Liu, H. (2021) Risk Factors for Residual Back Pain after Percutaneous Endoscopic Lumbar Discectomy. Journal of Orthopaedic Surgery and Research, 16, 84. |
| [22] | 杨阳, 黄华超, 庞爱华, 等. 骶骨裂孔成形术治疗腰椎间盘突出合并骶管狭窄的临床疗效[J]. 中国修复重建外科杂志, 2020, 34(9): 1138-1143. |
| [23] | 李军, 谭靖, 王振宇, 等. 腰椎管狭窄合并马尾神经受压的诊治体会[J]. 中国脊柱脊髓杂志, 2019, 29(3): 275-276. |
| [24] | Yan, L., Li, J., Luo, R., et al. (2021) Endoscopic Transforaminal Approach versus Conventional Posterior Approach for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Therapeutics and Clinical Risk Management, 17, 1227-1239. |
| [25] | Sedighi, M. and Haghnegahdar, A. (2014) Lumbar Disk Herniation Surgery: Outcome and Predictors. Global Spine Journal, 4, 233-243. https://doi.org/10.1055/s-0034-1390010 |
| [26] | Shin, J.S. and Youn, M.S. (2022) Endoscopic Lumbar Discectomy: Indications and Surgical Outcomes. Journal of Korean Neurosurgical Society, 65, 12-23. |
| [27] | Sun, T., Lu, H., Li, H., et al. (2021) Surface Electromyography-Based Evaluation of Paraspinal Muscle Activity and Fatigue in Patients with Lumbar Disc Herniation. Journal of International Medical Research, 49. |
| [28] | Peng, T., Jia, L.H., Li, L., et al. (2020) Value of Dynamic Paraspinal Mapping in Evaluating Lumbosacral Radiculopathy of Lumbar Disc Herniation Patients. Chinese Medical Journal (England), 133, 1887-1888. |
| [29] | Gao, Y., Zhang, Q., Liu, Y., et al. (2022) Mecobalamin Promotes the Recovery of Injured Sciatic Nerve in Mice through the Regulation of the Neurotrophic Factors. Aging (Albany NY), 14, 2464-2475. |
| [30] | 李永刚, 朱跃庆. 甲钴胺联合神经妥乐平治疗腰椎间盘突出症术后残余神经症状的疗效观察[J]. 中国现代医生, 2022, 60(9): 77-80. |
| [31] | Kaye, A., Urman, R., Rappaport, Y., Siddaiah, H., Cornett, E., Belani, K., et al. (2019) Multimodal Analgesia as an Essential Part of Enhanced Recovery Protocols in the Ambulatory Settings. Journal of Anaesthesiology Clinical Pharmacology, 35, S40-S45. https://doi.org/10.4103/joacp.joacp_51_18 |
| [32] | Ahn, Y., Lee, S.G., Son, S. and Keum, H.J. (2019) Transforaminal Endoscopic Lumbar Discectomy versus Open Lumbar Microdiscectomy: A Comparative Cohort Study with a 5-Year Follow-up. Pain Physician, 3, 295-304. https://doi.org/10.36076/ppj/2019.22.295 |
| [33] | Chen, H.J., Liang, L., Li, M., et al. (2021) Percutaneous Endoscopic Lumbar Discectomy Combined with Pulsed Radiofrequency for the Treatment of Lumbar Disc Herniation and Lumbar Facet Joint Pain. Wideochirurgia I Inne Techniki Maloinwazyjne, 16, 388-396. |
| [34] | Wu, W., Xia, J., Gao, B., Shi, L., Wang, S. and Liu, J. (2021) Full-Endoscopic Transforaminal Decompression for the Treatment of Symptomatic Lumbar Spinal Stenosis in the Elderly. Therapeutic Advances in Chronic Disease, 12. |
| [35] | 黄杰, 宋跃明. 腰椎融合术后疼痛的危险因素及多模式镇痛管理[J]. 中华疼痛医学杂志, 2019, 25(8): 561-566. |
| [36] | 马骁, 张猛, 刘松. 普瑞巴林治疗腰椎手术后神经根性疼痛的临床观察[J]. 中国疼痛医学杂志, 2020, 26(8): 615-618. |
| [37] | 詹友财, 彭程铭, 杨涛, 等. 腰椎间盘突出症术后功能康复训练的Meta分析[J]. 中华物理医学与康复杂志, 2021, 43(7): 682-688. |
| [38] | Mamamou, A.R., Zhang, X., Diebo, B.G., et al. (2022) Impact of Artificial Intelligence on Postoperative Outcomes in Spine Surgery: A Systematic Review. European Spine Journal, 31, 1395-1411. |
| [39] | Santos, B.A., Segura, J.M., E Silva, J.P. and Falavigna, A. (2022) Robot-Assisted Transforaminal Lumbar Interbody Fusion-Experience and Lessons from the First 93 Cases. World Neurosurgery, 161, e427-e434. |
| [40] | Galbusera, F., Casaroli, G. and Bassani, T. (2019) Artificial Intelligence and Machine Learning in Spine Research. JOR Spine, 2, e1044. https://doi.org/10.1002/jsp2.1044 |
| [41] | Park, J.W., Kang, D.G. and Kim, J.E. (2022) The Current Applications of Three-Dimensional Printing in Spine Surgery. Clinics in Orthopedic Surgery, 14, 1-9. |
| [42] | Xu, T., Tian, R., Qiao, P., et al. (2022) Mesenchymal Stem Cell Implantation for Lumbar Discogenic Low Back Pain: A Phase I/II, Open-Label, Single-Arm Clinical Trial and a Systematic Review. Pain Research and Management, 2022, Article ID: 1823347. |
