Tarlov囊肿静水压机制和手术疗效研究

Research on the Hydrostatic Pressure Mechanism and Surgical Efficacy of Tarlov Cysts

摘要:

目的 探讨神经根型骶管囊肿的囊内静水压机制及显微手术的临床疗效。方法 回顾性分析2016年11月—2019年6月在山西医科大学第二医院通过显微镜下神经束膜重建的手术方式治疗26例神经根型骶管囊肿患者的临床资料，包括症状特点、术中处理及术后随访。选择时间范围内的部分患者术中囊内静水压测量数据进行统计分析。结果 神经根型骶管囊肿患者以腰骶部和下肢疼痛为主要就诊症状。26例患者均予囊肿大部切除及神经根束膜重建显微手术治疗，术后无新发并发症。其中25例患者症状改善或消失（96.1%），1例无明显变化。术前囊内压力数值在不同体位下波动于3.1～12.4 mmHg；术后骶管内压力降至0.1～0.8 mmHg。结论 神经根型骶管囊肿可能与囊内静水压升高有关。显微镜下囊肿切除联合神经束膜重建术可缓解症状，是治疗神经根型骶管囊肿有效而安全的方法。

Abstract:

Abstract: Objective Tarlov cysts, also known as sacral perineural cysts, were first described by Tarlov in 1938, yet their clinical relevance and optimal management remain controversial. This study aimed to clarify the clinical significance of Tarlov cysts, investigate the role of intracystic hydrostatic pressure in symptom development, and evaluate the efficacy and safety of microsurgical perineurium reconstruction for sacral nerve root cysts. Methods A retrospective analysis was performed on 26 patients with sacral radicular cysts who underwent surgical treatment at the Second Hospital of Shanxi Medical University between November 2016 and June 2019. All patients received subtotal cyst resection combined with microsurgical perineurium reconstruction. Clinical manifestations, intraoperative findings, and postoperative outcomes were analyzed. In 10 patients, intracystic hydrostatic pressure was measured intraoperatively under different body positions. Postoperative follow-up ranged from 5 to 49 months, with a mean duration of 28.04 ± 12.57 months. Results The most common symptoms were lumbosacral pain and radiating pain in the lower extremities. All patients successfully underwent surgery without new neurological deficits, wound infection, or other surgery-related complications. Postoperative symptom improvement was observed in 25 patients (96.2%), while one patient (3.8%) showed no significant improvement. Both modified Japanese Orthopaedic Association (M-JOA) low back pain scores and Numeric Rating Scale (NRS) pain scores improved significantly after surgery (p < 0.05).. Preoperative intracystic pressure ranged from 3.1 to 12.4 mmHg under different body positions, whereas postoperative sacral canal pressure ranged from 0.1 to 0.8 mmHg.Conclusions Sacral radicular cysts may be associated with elevated intracystic hydrostatic pressure. Microsurgical subtotal cyst excision combined with perineurium reconstruction is a safe and effective surgical option, providing significant symptom relief with a low complication rate. Intraoperative measurement of intracystic hydrostatic pressure may serve as a useful adjunct for surgical evaluation.