本文關鍵詞： 腰椎1 微創(chuàng)2 椎管減壓術3　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討經(jīng)通道下單側(cè)入路雙側(cè)減壓、椎間融合、經(jīng)皮椎弓根釘內(nèi)固定術相較于傳統(tǒng)腰椎后路雙側(cè)經(jīng)椎間孔椎間融合、椎弓根釘內(nèi)固定術治療單節(jié)段退行性腰椎雙側(cè)側(cè)隱窩狹窄癥合并椎間不穩(wěn)的優(yōu)勢。方法:回顧性分析2014年9月至2016年9月在山西大醫(yī)院骨科行手術治療的75名單節(jié)段退行性腰椎雙側(cè)側(cè)隱窩狹窄癥合并有腰椎不穩(wěn)的患者,其中微創(chuàng)組患者35名,采用經(jīng)通道單側(cè)入路雙側(cè)減壓、椎間融合、經(jīng)皮椎弓根釘內(nèi)固定術;開放組患者40名,采用傳統(tǒng)腰椎后路雙側(cè)經(jīng)椎間孔椎間融合、椎弓根釘內(nèi)固定術。分別記錄75名患者術中出血量、術后住院時間及手術時間;記錄70名患者手術前及手術后1周、3個月、6個月腰痛視覺模擬評分(VAS),術前及術后3個月、6個月日本骨科協(xié)會評分(JOA)和Oswestry功能障礙指數(shù)(ODI),兩組患者對比評價手術效果。結果:所有患者采取微信平臺、電話等方式均獲得6個月隨訪。微創(chuàng)組患者手術時間為(134.3±8.7)ml,開放組患者手術時間為(134.9±8.9)ml,兩組對比差異無統(tǒng)計學意義(P0.05);微創(chuàng)組術中出血量為(108.7±13.6)ml,開放組術中出血量為(336.3±30.0)ml,兩組對比差異具有統(tǒng)計學意義(P0.05);術后住院時間微創(chuàng)組和開放組分別為(7.8±1.0)天、(14.1±1.3)天,兩組對比差異具有統(tǒng)計學意義(P0.05)。手術前兩組患者腰椎JOA評分、腰痛VAS評分和ODI指數(shù)差異無統(tǒng)計學意義(P0.05),組內(nèi)比較兩組患者術后各時間段腰椎JOA評分與術前相比具有明顯提高(P0.05),術后各時間段腰痛VAS評分與術前相比具有明顯降低(P0.05);術后第1周及第3個月微創(chuàng)組患者腰痛VAS評分均優(yōu)于開放組(P0.05),術后第6個月末次隨訪兩組腰痛VAS評分相比差異無統(tǒng)計學意義(P0.05);術后第3個月微創(chuàng)組腰椎JOA評分和ODI評分高于開放組(P0.05),術后第6個月末次隨訪微創(chuàng)組腰椎JOA評分和ODI評分與開放組相比差異無統(tǒng)計學意義(P0.05)。結論:微創(chuàng)通道下單側(cè)入路雙側(cè)減壓、椎間融合、經(jīng)皮椎弓根釘內(nèi)固定術在治療退行性雙側(cè)腰椎管側(cè)隱窩狹窄癥合并椎間不穩(wěn)上可以獲得與傳統(tǒng)腰椎后路雙側(cè)經(jīng)椎間孔椎間融合、椎弓根釘內(nèi)固定術相同的近期手術療效,且手術創(chuàng)傷小,住院時間短,特別是促進患者早期康復方面具有明顯優(yōu)勢。
[Abstract]:Objective: to investigate the bilateral decompression, intervertebral fusion and percutaneous pedicle screw fixation through the unilateral approach under the passage, compared with the traditional posterior lumbar intervertebral fusion. The advantages of pedicle screw internal fixation in the treatment of unilateral degenerative bilateral lumbar recess stenosis with intervertebral instability were analyzed retrospectively from September 2014 to September 2016 in the orthopedic department of Shanxi Provincial Hospital. Patients with bilateral recess stenosis associated with lumbar vertebrae instability, In the minimally invasive group, 35 patients were treated with bilateral decompression, intervertebral fusion and percutaneous pedicle screw fixation, while 40 patients in the open group were treated with traditional posterior lumbar intervertebral fusion. Intraoperative blood loss, postoperative hospital stay and operative time were recorded in 75 patients. Visual analogue scores of low back pain were recorded in 70 patients before operation and 1 week, 3 months and 6 months after surgery. The preoperative and postoperative scores of Japanese Orthopedic Association (JOAA) and the Oswestry dysfunction index were compared between the two groups. Results: all patients took the WeChat platform, The operation time was 134.3 鹵8.7 ml in the minimally invasive group and 134.9 鹵8.9 ml in the open group. There was no significant difference between the two groups (P 0.05), the intraoperative bleeding in the minimally invasive group was 108.7 鹵13.6 ml, and the intraoperative bleeding volume in the open group was 336.3 鹵30.0ml. The postoperative hospital stay in the minimally invasive group and the open group were 7.8 鹵1.0 days and 14.1 鹵1.3 days, respectively. The difference between the two groups was statistically significant (P 0.05). The JOA score of lumbar vertebrae in the two groups before operation was significantly higher than that in the control group. There was no significant difference in VAS score and ODI index of low back pain (P 0.05). The JOA score of lumbar vertebrae in the two groups was significantly higher than that before operation, and the VAS score of low back pain was significantly lower than that before operation. The VAS score of low back pain in the first week and the third month in the minimally invasive group was better than that in the open group. There was no significant difference in the VAS score of lumbar pain between the two groups at the sixth month after operation, and the JOA score of the lumbar vertebrae in the minimally invasive group at the third month after operation was higher than that in the open group. The scores and ODI scores of lumbar spine were higher in the open group than in the open group (P 0.05). There was no significant difference in the JOA score and ODI score of lumbar vertebrae between the minimally invasive group and the open group at the 6th month after operation. Conclusion: bilateral decompression via unilateral approach under minimally invasive channels is not significantly different from that in the open group. Intervertebral fusion and percutaneous pedicle screw fixation can be used to treat bilateral lumbar spinal canal stenosis with intervertebral instability. The internal fixation of pedicle screw had the same short-term curative effect, and the surgical trauma was small and the hospital stay was short, especially in promoting the early recovery of the patients.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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