發(fā)布時(shí)間：2018-02-10 10:57

  本文關(guān)鍵詞： 脊柱植入物 可擴(kuò)張通道 腰椎滑脫 微創(chuàng)　出處：《鄭州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:腰椎滑脫癥(spondylolisthesis)是脊柱滑脫中最常見的類型,是指腰椎某一節(jié)段相對(duì)于其臨近的節(jié)段出現(xiàn)出現(xiàn)位移,椎體滑移可以向前、后及側(cè)方滑移。其臨床癥狀的機(jī)制較為復(fù)雜,多為:①峽部裂引起的椎弓活動(dòng)異常;②滑脫節(jié)段序列錯(cuò)誤;③階段性不穩(wěn);④峽部裂處纖維軟骨組織壓迫神經(jīng)根;⑤合并椎間盤突出及椎管狹窄;⑥小關(guān)節(jié)退變等;手術(shù)目的在于恢復(fù)脊柱矢狀面上生理曲度,重建脊柱三柱結(jié)構(gòu)的連續(xù)性,恢復(fù)椎間隙高度,確�；摴�(jié)段的融合避免再次滑脫[1]。過去手術(shù)常采用原位融合,例如椎間植骨融合或橫突間植骨融合,術(shù)后常有再次滑脫傾向;近年,脊柱生物力學(xué)的發(fā)展及新型脊柱內(nèi)固定系統(tǒng)的研發(fā)及應(yīng)用,對(duì)于滑脫椎體的復(fù)位、融合有了新的認(rèn)識(shí),后路腰椎椎間植骨融合術(shù)(posterior lumbai interbody fusion,PLIF)聯(lián)合后路椎弓根螺釘內(nèi)固定,椎板切除、神經(jīng)根松解擴(kuò)大減壓cage置入術(shù)被廣泛應(yīng)用和推廣,并取得了一定的臨床療效。但手術(shù)對(duì)椎旁肌肉的廣泛剝離、術(shù)中切除棘突、棘間韌帶、椎板等后縱韌帶復(fù)合體,對(duì)脊柱后柱的破壞較大,造成脊柱穩(wěn)定性下降和術(shù)后患者遺留長(zhǎng)期腰背痛,影響患者生活質(zhì)量[2-5]。隨著微創(chuàng)技術(shù)的發(fā)展,Luxor微創(chuàng)通道系統(tǒng)輔助下經(jīng)椎旁多裂肌最長(zhǎng)肌間隙入路,微創(chuàng)治療腰椎退行性變的手術(shù)方式得到廣泛應(yīng)用,其具有創(chuàng)傷小,術(shù)中無需廣泛剝離椎旁肌肉、切除后縱韌帶復(fù)合體;術(shù)后恢復(fù)快,并發(fā)癥少的特點(diǎn)。目的:觀察Luxor通道系統(tǒng)輔助下經(jīng)多裂肌最長(zhǎng)肌間隙入路微創(chuàng)治療腰椎滑脫的早期的臨床療效。方法:回顧性分析2012年10月-2014年2月期間,我院骨科收治的采用Luxor通道下TLIF術(shù)治療腰椎滑脫患者36例,觀察術(shù)后3個(gè)月、一年患者ODI評(píng)分、VAS評(píng)分改善率,了解椎間融合情況及內(nèi)固定有無松脫、斷裂等情況。結(jié)果及結(jié)論:所有患者手術(shù)順利完成,無腦脊液漏及神經(jīng)損傷,術(shù)后1例切口感染、抗生素治療10天后感染控制,余患者切口均甲級(jí)愈合;所有患者均獲得隨訪,術(shù)后術(shù)后3個(gè)月及1年隨訪時(shí)ODI評(píng)分均較術(shù)前明顯恢復(fù),差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后3個(gè)月及1年時(shí)兩者ODI[6]評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05);隨訪1年時(shí)改善率為(65.3±14.8)%。術(shù)后3個(gè)月及1年隨訪時(shí)VAS評(píng)分均較術(shù)前明顯改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后3個(gè)月與1年隨訪時(shí)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后1年隨訪時(shí)改善率為(58.2±12.0)%。Luxor通道下TLIF術(shù)治療腰椎滑脫為微創(chuàng)治療腰椎滑脫的可行的手術(shù)方式,不僅能有效的糾正腰椎滑脫畸形、維持脊柱的生物力學(xué)穩(wěn)定、改善患者癥狀,還能降低患者術(shù)后腰背痛的發(fā)生率,獲得較高的生活質(zhì)量。
[Abstract]:Background: spondylolisthesis (spondylolisthesis) is the most common type of spondylolisthesis. It refers to the displacement of a segment of the lumbar vertebrae relative to the adjacent segment of the spondylolisthesis, which can slip forward, backward and lateral. The mechanism of its clinical symptoms is complicated. Most of them were due to abnormal pedicle activity caused by 1 / 1 isthmic fissure. (2) sequence errors in the segment of spondylolisthesis; (3) staggered instability; (3) compression of fibrous chondrocytes in the fissure of the isthmus with disc herniation and degeneration of 6 facet joints in spinal canal stenosis. The purpose of the operation is to restore the physiological curvature on the sagittal plane of the spine, to reconstruct the continuity of the three-column structure of the spine, to restore the height of the intervertebral space, and to ensure that the fusion of the segments of the slippage does not occur again [1]. For example, intervertebral bone graft fusion or intertransverse bone graft fusion often tends to slip again after surgery. In recent years, the development of spinal biomechanics and the development and application of new spinal internal fixation systems have gained a new understanding of the reduction and fusion of spondylolisthesis. Posterior lumbai interbody fusion combined with posterior pedicle screw fixation, laminectomy, nerve root decompression and cage implantation are widely used and popularized. But the extensive exfoliation of paravertebral muscles, the removal of spinous process, interspinous ligament, laminae and other posterior longitudinal ligamentum complex, which destroyed the posterior column of spinal column. With the development of minimally invasive technique, a Luxor minimally invasive channel system assisted approach to the longest muscle space of paraspinal polyfissure muscle was performed, which resulted in the reduction of spinal stability and long-term low back pain. Minimally invasive treatment of lumbar degenerative degeneration has been widely used, its trauma is small, there is no need for extensive exfoliation of the paraspinal muscles, resection of the posterior longitudinal ligament complex, the postoperative recovery is fast, Objective: to observe the early clinical effect of minimally invasive approach to lumbar spondylolisthesis via the longest intermuscular approach of polyfissure assisted by Luxor channel system. Methods: from October 2012 to February 2014, the clinical effects of lumbar spondylolisthesis were retrospectively analyzed. 36 cases of lumbar spondylolisthesis were treated with TLIF under Luxor channel in our orthopedic department. The improvement rate of ODI score was observed in 3 months and one year after operation, and the intervertebral fusion and internal fixation were observed. Results and conclusion: no cerebrospinal fluid leakage and nerve injury were successfully completed in all patients. Infection was controlled in 1 case of incision infection 10 days after antibiotic treatment. After 3 months and 1 year follow-up, the ODI scores were significantly recovered compared with those before operation. The difference was statistically significant (P 0.05). There was no significant difference in ODI [6] scores between the two groups at 3 months and 1 year postoperatively, and the improvement rate was 65.3 鹵14.8% at 1 year follow-up. The VAS scores at 3 months and 1 year follow-up were significantly improved compared with those before operation. The difference was statistically significant (P 0.05), and there was no significant difference between 3 months after operation and 1 year follow-up (P 0.05), and the improvement rate at 1 year follow-up was 58.2 鹵12.0%. The feasible operative method for lumbar spondylolisthesis was treated with TLIF under Luxor channel for minimally invasive treatment of lumbar spondylolisthesis. It can not only effectively correct the lumbar spondylolisthesis deformity, maintain the biomechanical stability of the spine, improve the symptoms of the patients, but also reduce the incidence of postoperative low back pain, and obtain a higher quality of life.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 劉星;劉志勇;;針刀治療退行性腰椎滑脫癥45例[J];江西中醫(yī)藥;2010年07期

2 李志琳;厲孟;竇強(qiáng);藍(lán)旭;甄平;葛寶豐;;Quadrant通道下TLIF聯(lián)合UPASS Ⅱ經(jīng)皮椎弓根螺釘內(nèi)固定治療腰椎滑脫[J];頸腰痛雜志;2013年05期

3 劉保華;王沛;夏群;馮世慶;鄭永發(fā);李冰;;椎弓根螺釘置入內(nèi)固定與單純椎管減壓治療退行性腰椎滑脫的比較[J];中國(guó)組織工程研究與臨床康復(fù);2011年04期

4 靳安民,姚偉濤,張輝;腰椎間盤突出癥術(shù)后療效不佳的原因分析及對(duì)策[J];中華骨科雜志;2003年11期

5 黎慶初;胡輝林;劉寶戈;閆慧博;金大地;;多裂肌間隙入路微創(chuàng)手術(shù)治療腰椎滑脫癥[J];中國(guó)脊柱脊髓雜志;2011年04期

6 王志榮;陸愛清;楊惠林;王素春;陳勇;陳國(guó)平;;Quadrant通道下TLIF術(shù)治療復(fù)發(fā)性腰椎間盤突出癥的療效分析[J];中國(guó)脊柱脊髓雜志;2014年02期

7 桂柯科;俞永林;趙明東;譚德炎;尹望平;;中國(guó)人Wiltse椎旁肌間隙入路的觀察與測(cè)量[J];中國(guó)組織工程研究;2014年22期

，

本文編號(hào)：1500355