本文關鍵詞： 后路椎間融合 退行性腰椎滑脫 相對椎間高度　出處：《蘇州大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:評價經(jīng)后路腰椎管減壓椎弓根內固定椎間融合術治療退行性腰椎滑脫伴椎管狹窄癥的臨床療效。方法:對2013年2月至2014年10月收入蘇州大學附屬第二醫(yī)院骨外科的35例退行性腰椎滑脫伴椎管狹窄癥的患者(平均年齡55.78±10.12歲,其中男性8例,女性27例,I度滑脫28例,II度滑脫7例,滑脫節(jié)段均為L4-5),行后路椎管減壓椎間融合(posterior lumbar interbody fusion PLIF)+椎弓根內固定術治療,對患者進行手術后隨訪,隨訪時間為術后1個月、6個月、12個月。記錄患者手術前、術后1個月、6個月、12個月按日本骨科協(xié)會(Japanese Orthopaedic Association JOA)評分和Oswestry功能障礙指數(shù)(Oswestry disability index ODI)來評估疼痛緩解及功能改善情況;影像學通過X線檢查測量患者手術前后滑脫率、滑脫節(jié)段及鄰近節(jié)段相對椎間隙高度,滑脫節(jié)段前凸角(Segmental Lordosis,SL),觀察末次隨訪時的融合節(jié)段骨性愈合情況,通過比較手術前后滑脫率,相對椎間高度及SL來評價影像學改善情況。所有數(shù)據(jù)采用SPSS17.0統(tǒng)計學分析。結果:35例患者均順利完成手術,平均手術時間為129.2±26.6min;平均出血量469.6±106.3ml,其中1例發(fā)生硬脊膜破裂,3例出現(xiàn)神經(jīng)根牽扯痛,經(jīng)對癥治療均治愈�；颊咝g后1個月、6個月及12個月的JOA評分分別為23.33±2.06、24.19±2.34、25.14±2.33,與術前15.24±2.97相比均顯著提高,差異有統(tǒng)計學意義(P0.01);優(yōu)17例,良15例,可3例,差0例,優(yōu)良率為91.4%;ODI評分分別為:15.36±5.36、10.12±5.18、10.06±5.31,較術前43.05±7.26均明顯降低,差異有統(tǒng)計學意義(P0.01),術后6天的相對椎間隙高度12.2±2.0mm與術前10.6±2.3mm比較有明顯增加(P0.05),與術后各時間點比較變化不大(P0.05),滑脫率術后6天0.11±0.03與術前0.36±0.05比較,差異有統(tǒng)計學意義(P0.05),與術后各時間點比較變化不大(P0.05),SL術后6天5.1±1.6與術前6.2±1.8比較差異明顯(P0.05),與末次隨訪5.0±1.5比較變化不大(P0.05)。隨訪期間無內固定器械松動、斷裂、融合器移位、不融合及鄰近節(jié)段退變(ASD)等并發(fā)癥。結論:經(jīng)后路椎管減壓椎弓根內固定椎間融合術治療伴有椎管狹窄癥狀的腰椎滑脫癥是一種有效的治療方式。
[Abstract]:Objective: To evaluate the clinical efficacy of posterior lumbar canal decompression and pedicle screw fixation and interbody fusion for degenerative lumbar spondylolisthesis with spinal stenosis. Methods: 35 cases of degenerative lumbar spondylolisthesis from February 2013 to October 2014 the income of The Second Hospital Affiliated to Suzhou University bone surgery with spinal stenosis patients (mean age 55.78 + 10.12 years, including 8 cases of male, female 27 cases. I spondylolisthesis in 28 cases, 7 cases of II spondylolisthesis, slippage section was L4-5), posterior decompression and interbody fusion (posterior lumbar interbody fusion PLIF) + pedicle fixation. The patients were followed up after operation, the follow-up time was 1 months after surgery, 6 months, 12 months. Records of patients before surgery, 1 months after surgery, 6 months, 12 months in Japan (Japanese Orthopaedic Association JOA Department of orthopedics Association) scores and Oswestry disability index (Oswestry disability index ODI) to assess Pain relief and functional improvement; imaging by X-ray measurement in patients with spondylolisthesis rate before and after surgery, spondylolisthesis segment and adjacent segment relative slippage of intervertebral height and segmental lordosis (Segmental Lordosis, SL), at the end of the follow-up observation fusion segment bone healing, by comparing the rate of detachment before and after operation, the relative the intervertebral height and SL to evaluate the radiographic improvement. All data using SPSS17.0 statistical analysis. Results: 35 patients were successfully operated, the average operation time was 129.2 + 26.6min; the average amount of bleeding was 469.6 + 106.3ml, 1 cases of dural rupture, 3 cases of nerve root pain, symptomatic treatment cured. 1 months after surgery, 6 months and 12 months JOA score were 23.33 + 2.06,24.19 + 2.34,25.14 + 2.33, 15.24 + 2.97 compared with before operation were significantly increased, the difference was statistically significant (P0.01); 17 cases were excellent, 15 good 渚，

本文編號：1521938