本文關(guān)鍵詞： Quadrant微創(chuàng)系統(tǒng) TLIF 單間隙 腰椎退行性病變　出處：《山東大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：探討Quadrant微創(chuàng)系統(tǒng)輔助下經(jīng)椎間孔椎間融合手術(shù)(transforaminal lumbar interbody fusion, TLIF)應(yīng)用于單間隙腰椎退行性病變的安全性及臨床治療效果,以期為選擇治療該病的理想術(shù)式方面提供參考。方法：1.研究對(duì)象及分組：選取2012年1月—-2014年1月我院收治的單間隙腰椎退變性疾病患者62例作為研究對(duì)象,采用隨機(jī)數(shù)字表法分為2組：微創(chuàng)組和開(kāi)放組。2.研究方法：微創(chuàng)組31例患者均行Quadrant微創(chuàng)系統(tǒng)輔助下的TLIF手術(shù)治療,開(kāi)放組31例患者均行開(kāi)放TLIF手術(shù)治療。分別記錄兩組患者的手術(shù)時(shí)間、切口長(zhǎng)度、術(shù)中出血量、術(shù)后引流量等相關(guān)指標(biāo)；同時(shí),檢測(cè)兩組患者術(shù)前和術(shù)后一天內(nèi)C反應(yīng)蛋白(CRP)以及肌酸激酶(CK)的水平,以此判斷肌肉組織受損程度；對(duì)全部患者進(jìn)行為期1年的跟蹤查訪,通過(guò)視覺(jué)模擬(VAS)評(píng)分和Oswestry功能障礙指數(shù)(ODI)來(lái)評(píng)價(jià)患者不同時(shí)期的疼痛程度,并觀察患者有無(wú)出現(xiàn)近期和遠(yuǎn)期并發(fā)癥。結(jié)果：1.手術(shù)相關(guān)指標(biāo)比較：兩組手術(shù)相關(guān)指標(biāo)相比,微創(chuàng)組手術(shù)時(shí)間(2.75±0.36)h、切口長(zhǎng)度(3.64±0.31)cm、術(shù)中出血量(219.52±105.17)ml、術(shù)后引流量(73.824±21.97)ml、術(shù)后在院時(shí)間(5.21±0.89)d,開(kāi)放組手術(shù)時(shí)間(2.89±0.43)h、切口長(zhǎng)度(8.79±1.24)cm、術(shù)中出血量(642.82±198.64)ml、術(shù)后引流量(231.03±73.64)ml、術(shù)后在院時(shí)間(7.32±2.01)d。在切口長(zhǎng)度、術(shù)中出血量、術(shù)后引流量和術(shù)后住院時(shí)間上,微創(chuàng)組顯著優(yōu)于開(kāi)放組(P均0.05),手術(shù)時(shí)間相比兩組則無(wú)統(tǒng)計(jì)學(xué)差別(P0.05)。2.術(shù)中X線暴露情況：微創(chuàng)組的x線放射時(shí)長(zhǎng)、DAP及SED顯著高于開(kāi)放組(P均0.05),差異均具有統(tǒng)計(jì)學(xué)意義,微創(chuàng)組術(shù)中X線暴露情況更嚴(yán)重。3.兩組VAS、ODI評(píng)分比較：開(kāi)放組術(shù)前VAS、ODI評(píng)分分別為(8.7±1.0)分、(45.7±1.8)分,微創(chuàng)組術(shù)前VAS、ODI評(píng)分分別為(8.8±1.1)分,(45.6±1.7)分,兩組術(shù)后VAS評(píng)分、ODI評(píng)分均顯著下降(P0.05)。隨訪結(jié)果還顯示,微創(chuàng)組患者在術(shù)后半個(gè)月、3個(gè)月、6個(gè)月時(shí)的VAS評(píng)分及ODI評(píng)分,兩項(xiàng)均要顯著低于開(kāi)放組患者(P均0.05),但在術(shù)后1年時(shí)兩組的評(píng)分相比均沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05)。4.兩組CRP、CK水平比較：兩組術(shù)前CRP、CK水平無(wú)差異(P0.05)。術(shù)后第一天,微創(chuàng)組CRP、CK水平較開(kāi)放組低(P0.05),差異有統(tǒng)計(jì)學(xué)意義。5.兩組并發(fā)癥及恢復(fù)情況：全部62例患者均治療順利且痊愈出院。開(kāi)放組3例患者出現(xiàn)手術(shù)切口感染,在使用抗生素治療后均在2周內(nèi)痊愈,所有患者患者未發(fā)生定位偏差、腦脊液漏、神經(jīng)受損等并發(fā)癥。隨訪結(jié)果顯示,兩組患者植骨均表現(xiàn)為較佳的骨性融合。結(jié)論：1.Quadrant微創(chuàng)系統(tǒng)輔助下TLIF手術(shù)與開(kāi)放TLIF手術(shù)相比,術(shù)中對(duì)患者腰椎周?chē)鷻C(jī)體組織造成的傷害更小,具有手術(shù)時(shí)間短、術(shù)中出血量少等優(yōu)勢(shì),但手術(shù)醫(yī)師術(shù)中X線暴露的時(shí)間較長(zhǎng)。2. Quadrant微創(chuàng)系統(tǒng)輔助下TLIF對(duì)患者組織損傷相關(guān)生化指標(biāo)的影響較小,機(jī)體發(fā)生的應(yīng)激反應(yīng)較輕,具有微創(chuàng)的特點(diǎn)。3.Quadrant微創(chuàng)系統(tǒng)輔助下TLIF與開(kāi)放TLIF的遠(yuǎn)期療效均非常良好,但Quadrant微創(chuàng)系統(tǒng)輔助下TLIF能夠在術(shù)后較短時(shí)間內(nèi)較快地提升患者的生活質(zhì)量,近期療效更佳。4. Quadrant微創(chuàng)系統(tǒng)輔助下TLIF手術(shù)是治療腰椎退行性病變的一種非常安全有效的手術(shù)方式,它彌補(bǔ)了既往開(kāi)放TLIF手術(shù)的某些弊端,體現(xiàn)了現(xiàn)代脊柱外科手術(shù)微創(chuàng)的理念,值得在臨床上推廣使用。
[Abstract]:Objective: To investigate the Quadrant system assisted minimally invasive transforaminal lumbar fusion surgery (transforaminal lumbar, interbody fusion, TLIF) the safety and clinical therapeutic effect applied to a single level lumbar degenerative disease, so as to provide reference for the choice of ideal surgical treatment of the disease. Methods: 1. subjects and groups: select January 2012 -2014 year in January in our hospital were single gap lumbar degenerative diseases in 62 patients as the research object, randomly divided into 2 groups: minimally invasive group and open group.2. methods: minimally invasive group 31 patients underwent minimally invasive surgical treatment of TLIF Quadrant system assisted by the open group, 31 patients underwent open TLIF surgery were recorded in two groups of patients with operation time, incision length, intraoperative bleeding, postoperative drainage and other related indicators; at the same time, detection of a day of two groups of patients before and after operation in C 鍙嶅簲铔嬬櫧(CRP)浠ュ強(qiáng)鑲岄吀嬋，

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