本文選題：CT椎管測量　切入點(diǎn)：開窗　出處：《甘肅中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對采用多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療退變性腰椎管狹窄癥的患者,手術(shù)前后進(jìn)行CT椎管測量分析及臨床評價(jià),共同探討多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療退變性腰椎管狹窄癥的臨床療效。并對圍手術(shù)期應(yīng)用甘肅省中醫(yī)院自制藥劑“消腫止痛合劑”對患者的影響進(jìn)行臨床對比觀察,以期探討多節(jié)段椎板開窗潛行擴(kuò)大術(shù)及圍手術(shù)期應(yīng)用“消腫止痛合劑”治療退變性腰椎管狹窄癥的安全性和有效性,并為此方案治療退變性腰椎管狹窄癥提供臨床依據(jù)。方法:嚴(yán)格按照退變性腰椎管狹窄癥手術(shù)的納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn),入選2014年3月~2015年9月甘肅省中醫(yī)院脊柱骨三科所收治的退變性腰椎管狹窄癥患者60例。以就診順序,將60例退變性腰椎管狹窄癥患者隨機(jī)分為兩組,每組各30例,60例患者均采用多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療。術(shù)前及術(shù)后對60例患者行腰椎CT掃描,運(yùn)用Digimizer圖像分析測量軟件對CT掃描片進(jìn)行椎管矢徑、椎板間距、上關(guān)節(jié)突內(nèi)緣間距、椎管截面積的測量;對60例患者手術(shù)前后進(jìn)行JOA評分(日本骨科學(xué)會(huì)下腰痛評分法)及VAS評分(視覺模擬評分法),對術(shù)前及術(shù)后所測得的椎管數(shù)據(jù)及評分結(jié)果進(jìn)行比較評價(jià),以分析多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療退變性腰椎管狹窄癥的療效。術(shù)后,一組患者給予常規(guī)對癥治療如抗炎、補(bǔ)液等,作為手術(shù)治療組;另一組患者在以上常規(guī)治療的基礎(chǔ)上,術(shù)后3天給予甘肅省中醫(yī)院自制藥劑“消腫止痛合劑”,作為手術(shù)及圍手術(shù)期應(yīng)用中藥治療組�！跋[止痛合劑”用法:口服,50ml/次,3次/天,服用4周。通過對兩組患者JOA及VAS評分結(jié)果的組間比較,分析“消腫止痛合劑”對患者術(shù)后的影響。在上述研究結(jié)果及統(tǒng)計(jì)學(xué)分析的基礎(chǔ)上,綜合分析多節(jié)段椎板開窗潛行擴(kuò)大術(shù)及圍手術(shù)期應(yīng)用消腫止痛合劑治療退變性腰椎管狹窄癥的安全性和有效性。結(jié)果:將本研究60例患者手術(shù)前后所攝取的CT掃描片運(yùn)用Digimizer圖像分析軟件測量后得出,各測量平面的椎管矢徑、椎板間距、上關(guān)節(jié)突內(nèi)緣間距、椎管截面積均比術(shù)前顯著增大,且P0.05,具有統(tǒng)計(jì)學(xué)意義。說明60例患者通過多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療后,原本狹窄的椎管得到了充分的減壓、擴(kuò)大。通過VAS評分結(jié)果比較,采用多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療后,兩組60例患者的疼痛情況均比治療前明顯緩解,P0.05;且兩組間比較,手術(shù)及圍手術(shù)期應(yīng)用中藥治療組的疼痛緩解情況要優(yōu)于手術(shù)治療組,P0.05。根據(jù)JOA評分結(jié)果比較,采用多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療后,兩組60例患者均比治療前功能恢復(fù)明顯,P0.05;根據(jù)兩組患者治療前及治療后3個(gè)月的JOA評分計(jì)算改善率,手術(shù)及圍手術(shù)期應(yīng)用中藥治療組平均改善率為86.90%,手術(shù)治療組平均改善率為80.93%,兩組患者通過多節(jié)段椎板開窗潛行擴(kuò)大術(shù)治療后改善率均達(dá)到“優(yōu)”標(biāo)準(zhǔn),且手術(shù)及圍手術(shù)期應(yīng)用中藥治療組改善率高于手術(shù)治療組。結(jié)論:多節(jié)段椎板開窗潛行擴(kuò)大術(shù)能夠保留腰椎后部大部分骨韌帶結(jié)構(gòu),盡量減小對脊柱的破壞,并對中央椎管及神經(jīng)根管狹窄部分、側(cè)隱窩進(jìn)行充分徹底的減壓,改善了馬尾神經(jīng)、神經(jīng)根的血液循環(huán)及功能,解除了患者下肢麻木、疼痛、無力,間歇性跛行等臨床癥狀,極大的提高了患者的工作生活質(zhì)量。與其他手術(shù)方式相比,在保證脊柱穩(wěn)定與充分減壓之間,找到了更好的平衡,值得臨床推廣。同時(shí),圍手術(shù)期應(yīng)用中藥“消腫止痛合劑”在治療退變性腰椎管狹窄癥與促進(jìn)患者術(shù)后恢復(fù)方面,取得了良好的效果,體現(xiàn)了中西醫(yī)結(jié)合治療退變性腰椎管狹窄癥的優(yōu)勢,是安全可靠的治療方案。
[Abstract]:Objective: to adopt multi segmental fenestration laminectomy augmentation in treatment of degenerative lumbar spinal stenosis patients before and after surgery and clinical evaluation of spinal CT measurement, discuss multi segmental fenestration for treatment of clinical curative effect of enlarge undercutting of degenerative lumbar spinal stenosis. And the perioperative application of TCM Hospital of Gansu province homemade pharmacy "swelling" Zhitong mixture for patients with clinical observation, to evaluate the effectiveness and safety of multisegmental laminectomy fenestration enlargement and perioperative application of "Xiaozhongzhitong mixture" in the treatment of degenerative lumbar spinal stenosis in order to provide the clinical basis for the treatment of degenerative lumbar spinal stenosis. Methods: according to the strict inclusion of degenerative lumbar stenosis surgery criteria, selected in March 2014 September ~2015 spine Hospital of Gansu Province, three from degeneration 60 cases of lumbar spinal stenosis patients. In clinical order. 60 cases of degenerative lumbar spinal stenosis were randomly divided into two groups, each group of 30 cases, 60 cases were treated with multisegmental laminectomy fenestration expand surgery. Preoperative and postoperative in 60 cases of patients with lumbar CT scan, using Digimizer image analysis the measurement software of CT scans of sagittal diameter of the spinal canal, posterior superior facet spacing, edge distance, measuring the cross-sectional area of spinal canal; JOA score of 60 cases of patients before and after surgery (Japanese Department of orthopedics Association low back pain score) and VAS score (visual analogue scale), to evaluate the spinal canal and the results measured by the score data well before and after surgery, to analyze the multi segmental fenestration laminectomy expanding effect in treatment of degenerative lumbar spinal stenosis. Postoperative treatment such as anti-inflammatory, a group of patients given conventional symptomatic fluid infusion, surgery as treatment group; another group of patients The conventional treatment based on the above, the 3 day after the Gansu Provincial Hospital of traditional Chinese medicine pharmacy homemade "Xiaozhongzhitong mixture", as the surgical and perioperative application of traditional Chinese medicine treatment group. "Xiaozhongzhitong mixture" usage: oral, 50ml/ time, 3 times / day, taking 4 weeks. By the comparison of two groups of patients with JOA and VAS scores between groups, analysis of the influence of "Xiaozhongzhitong mixture" on postoperative patients. Based on analysis of the research results and statistics, a comprehensive analysis of the safety and effectiveness of multi segmental fenestration laminectomy enlargement and perioperative application of Xiaozhongzhitong mixture in the treatment of degenerative lumbar spinal stenosis. Results: the study of 60 patients before and after surgery the intake of CT scans using Digimizer image analysis software measurement results, the measurement plane of the sagittal diameter of the spinal canal, posterior superior facet spacing, edge distance, spinal canal cross-sectional area were compared with preoperative significant Increased, and P0.05, with statistical significance. 60 patients with multisegmental laminectomy fenestration enlargement after treatment had stenosis of the vertebral canal was fully expanded. Through decompression, VAS scores were compared with multiple segmental fenestration laminectomy enlargement after treatment, the pain of two groups of 60 patients than before treatment significantly alleviated, P0.05; and the comparison between the two groups. The pain of surgery and perioperative application of traditional Chinese medicine treatment group to ease the situation better than the surgical treatment group, P0.05. according to the JOA scores compared with multiple segmental fenestration laminectomy enlargement after treatment, two groups of 60 patients were recovered obviously than before treatment, P0.05; according to the two groups before and after treatment for 3 months JOA score improvement rate was calculated, surgical and perioperative application of traditional Chinese medicine treatment group, the average improvement rate was 86.90%, treatment group average improvement rate was 80.93%, two groups of patients Expand the treatment of multi segmental fenestration laminectomy by improved rate of "excellent" standard, and the surgical and perioperative application of traditional Chinese medicine treatment group improved rate is higher than the surgical treatment group. Conclusion: multi segmental fenestration operation can retain the posterior lumbar spile expand most bone ligament structure, reduce the damage to the spine. And part of the central spinal canal stenosis and nerve root, lateral recess were completely decompression, improve the cauda equina, blood circulation and nerve root function, relieve patients pain, weakness, numbness, intermittent claudication clinical symptoms, greatly improves the work quality of life of patients compared with other surgical methods. And in ensuring the spinal stability and sufficient decompression, found a better balance, it is worthy of clinical promotion. At the same time, the application of traditional Chinese medicine "peri operation period Xiaozhongzhitong mixture" in the treatment of degenerative lumbar spinal stenosis It has achieved good results in promoting postoperative recovery. It reflects the advantages of integrated traditional Chinese and Western medicine in the treatment of degenerative lumbar spinal stenosis, and is a safe and reliable treatment plan.

【學(xué)位授予單位】：甘肅中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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