本文選題：腰椎間盤突出癥　切入點：鈣化型　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討經(jīng)椎板間入路全內(nèi)鏡手術(shù)(Full endoscopic technique,FET)治療鈣化型腰椎間盤突出癥的臨床療效。方法:收集我院脊柱外科從2014年8至2016年11月收治鈣化型腰椎間盤突出癥的患者15例,采用經(jīng)椎板間入路全內(nèi)鏡手術(shù)治療,記錄患者手術(shù)時間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后復(fù)發(fā)及術(shù)后住院時間等情況,隨訪6個月,分別比較患者術(shù)前與術(shù)后1d、術(shù)后3個月及術(shù)后6個月的功能障礙指數(shù)(Oswestry Disability Index,ODI)、視覺模擬評分(Visual Analogue Scale,VAS),采用術(shù)后3個月MacNab改良的療效評價評估手術(shù)療效,所有患者均行腰椎正側(cè)位片、腰椎電子計算機斷層掃描(Computed tomography,CT)及磁共振成像(Magnetic resonance imaging,MRI)檢查。結(jié)果:本組病例中,手術(shù)時間在77-101分鐘,平均手術(shù)時間為88分鐘,術(shù)中無明顯出血,所有病例均在內(nèi)鏡下順利完成,無術(shù)中并發(fā)癥的發(fā)生,隨訪至今所有病例無一例出現(xiàn)術(shù)后復(fù)發(fā),術(shù)后住院時間為2-3天;術(shù)前ODI指數(shù)為82.5±5.0,術(shù)后1天、術(shù)后3個月、6個月ODI指數(shù)分別為27.1±3.4、24.1±3.5、22.4±2.5,術(shù)前ODI指數(shù)分別與術(shù)后1天、3個月及6個月ODI指數(shù)比較,差異均有統(tǒng)計學(xué)意義(P0.05),術(shù)后1天ODI指數(shù)分別與術(shù)后3個月及術(shù)后6個月ODI指數(shù)比較,差異均有統(tǒng)計學(xué)意義(P0.05);術(shù)前VAS評分為7.8±0.7,術(shù)后1天、術(shù)后3個月、術(shù)后6個月VAS評分分別為2.5±0.7、2.0±0.5、1.5±0.5,術(shù)前VAS評分分別與術(shù)后1天、術(shù)后3個月及6個月VAS評分比較,差異均有統(tǒng)計學(xué)意義(P0.05),術(shù)后1天VAS評分分別與術(shù)后3個月及術(shù)后6個月VAS評分比較,差異均有統(tǒng)計學(xué)意義(P0.05);術(shù)后3月根據(jù)改良MacNab標準療效評價,優(yōu)12例、良2例、可1例、差0例,優(yōu)良率93.3%(14/15);術(shù)后CT及MRI提示突出鈣化的椎間盤組織被切除。結(jié)論:經(jīng)椎板間入路全內(nèi)鏡手術(shù)治療鈣化型腰椎間盤突出癥具有短期療效確切、出血量少、手術(shù)時間短、并發(fā)癥少、術(shù)后康復(fù)快等特點。
[Abstract]:Objective: to investigate the clinical effect of full endoscopic technique (FET) through interlaminar approach in the treatment of calcified lumbar disc herniation. Methods: from 2014 to November 2016, 15 patients with calcified lumbar disc herniation in our hospital were collected. Patients were treated with total endoscopy via interlaminar approach. The time of operation, blood loss, complications, postoperative recurrence and postoperative hospital stay were recorded and followed up for 6 months. Oswestry Disability index index (Oswestry Disability index) and visual analogue score (VAS) were compared between preoperative and postoperative 1 day, 3 months after operation and 6 months after operation respectively. Three months after operation, the modified MacNab was used to evaluate the outcome of the operation. All the patients were given Lumbar Lumbar anterior and lateral radiographs. Results: the operation time was 77-101 minutes, the average operation time was 88 minutes, there was no obvious bleeding during the operation, all cases were successfully completed under endoscope. No intraoperative complications occurred, no recurrence occurred in all cases, the postoperative hospitalization time was 2-3 days, the preoperative ODI index was 82.5 鹵5.0, and the postoperative ODI index was 1 day after operation. The ODI index at 3 months and 6 months after operation was 27.1 鹵3.4 鹵3.5 鹵22.4 鹵2.5, respectively. The ODI index of preoperative ODI was significantly higher than that of 1 day, 3 months and 6 months after operation (P 0.05). The ODI index of 1 day after operation was compared with that of 3 months after operation and 6 months after operation. The difference was statistically significant (P < 0.05), the preoperative VAS score was 7.8 鹵0.7, the VAS score at 1 day, 3 months after operation and 6 months after operation was 2.5 鹵0.7 鹵0.5 鹵0.5, respectively. The VAS score before operation was compared with that at 1 day, 3 months and 6 months after operation, respectively. The difference was statistically significant (P 0.05), the VAS score on the 1st day after operation was significantly higher than that at 3 months and 6 months after operation (P 0.05), and on March, according to the modified MacNab standard, 12 cases were excellent, 2 cases were good, 1 case was fair. After operation, CT and MRI showed that calcified intervertebral disc was excised. Conclusion: the treatment of calcified lumbar disc herniation by total endoscopy via interlaminar approach is effective in the short term, with less bleeding and shorter operation time. Few complications and quick recovery after operation.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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