本文選題：腰椎間盤突出癥　切入點(diǎn)：動(dòng)態(tài)內(nèi)固定　出處：《蘇州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：一、研究目的回顧性研究Cosmic單側(cè)非融合動(dòng)態(tài)內(nèi)固定和單側(cè)融合內(nèi)固定兩種方法治療腰椎間盤突出癥的臨床療效。二、研究方法從2010年1月至2012年9月,對(duì)36例腰椎間盤突出癥(L5S1)患者分別采用髓核摘除Cosmic單側(cè)非融合內(nèi)固定(18例)和髓核摘除單側(cè)融合內(nèi)固定(18例)進(jìn)行手術(shù)治療;非融合組18例,男8例,女10例,年齡40-59歲,平均49歲;融合組18例,男11例,女7例,年齡37-60歲,平均48.5歲。所有患者術(shù)前均行腰椎正側(cè)位及過(guò)伸過(guò)屈位X線片、腰椎CT以及腰椎MRI檢查。共手術(shù)36例,術(shù)后進(jìn)行隨訪,36例均獲得隨訪,其中Cosmic單側(cè)固定非融合組隨訪時(shí)間為12至25個(gè)月,平均隨訪時(shí)間為19.5個(gè)月,單側(cè)內(nèi)固定融合組隨訪時(shí)間為12至26個(gè)月,平均隨訪時(shí)間為20.5個(gè)月。期間記錄兩組手術(shù)時(shí)間,術(shù)中出血量;分別評(píng)估患者術(shù)前及術(shù)后末次隨訪時(shí)痛視覺(jué)模擬評(píng)分(visual analogue scale,VAS)、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評(píng)分,并進(jìn)行統(tǒng)計(jì)學(xué)分析比較;在腰椎動(dòng)力位X線片上分別測(cè)量并記錄患者術(shù)前及術(shù)后末次隨訪時(shí)手術(shù)節(jié)段(L5S1)、鄰近節(jié)段(L4,5)和腰椎(L1S1)的活動(dòng)度(range of motion,ROM),并進(jìn)行統(tǒng)計(jì)學(xué)分析比較。三、研究結(jié)果所有患者術(shù)后切口I期愈合。兩組患者截止至末次隨訪期間未有神經(jīng)根損傷、感染、腦脊液漏、椎間盤突出復(fù)發(fā)、融合器移位及內(nèi)固定植入物松動(dòng)斷裂等并發(fā)癥。對(duì)手術(shù)時(shí)間及術(shù)中出血量進(jìn)行統(tǒng)計(jì)學(xué)分析比較(見表1),非融合組及融合組平均手術(shù)時(shí)間分別為72±3.1min及98.0±2.9min,術(shù)中平均出血量依次分別為131.0±8.0ml及166.0±8.1ml,且兩比較項(xiàng)差異均有統(tǒng)計(jì)學(xué)意義(P0.01),即融合組手術(shù)時(shí)間及術(shù)中出血量均高于非融合組(P0.01)。對(duì)兩組患者術(shù)前術(shù)后(末次隨訪)VAS及ODI評(píng)分進(jìn)行統(tǒng)計(jì)學(xué)分析比較(見表2),非融合組術(shù)前及末次隨訪VAS評(píng)分分別為7.0±1.5分及2.8±1.1分,術(shù)前及末次隨訪ODI評(píng)分分別為44.0±5.4分及18.1±5.0分;融合組術(shù)前及末次隨訪VAS評(píng)分分別為8.0±1.5分及3.0±1.8分,術(shù)前及末次隨訪ODI評(píng)分分別為46.0±6.2分及19.1±4.9分。縱向比較術(shù)前及術(shù)后末次隨訪之VAS評(píng)分及ODI評(píng)分,兩組差異均有統(tǒng)計(jì)學(xué)意義(P0.01),兩組患者術(shù)后的ODI及VAS評(píng)分較術(shù)前均有明顯改善。橫向比較非融合組及融合組組間,相對(duì)應(yīng)時(shí)段的VAS評(píng)分及ODI評(píng)分,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。即依據(jù)VAS評(píng)分及ODI評(píng)分來(lái)評(píng)估治療效果,則兩組在腰椎間盤突出癥治療上均有顯著效果,而兩組間治療效果則無(wú)明顯差別。對(duì)兩組患者術(shù)前術(shù)后各節(jié)段ROM(°)進(jìn)行統(tǒng)計(jì)學(xué)分析比較(見表3)。非融合組術(shù)前ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分別為5.6±1.6°、8.0±1.2°及21.1±3.8°,術(shù)后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分別為5.1±1.0°、7.2±1.1°及21.4±1.9°;融合組術(shù)前ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分別為6.2±2.0°、8.0±1.7°及21.2±4.6°,術(shù)后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分別為1.5±1.0°、6.3±1.5°及19.6±2.2°。兩組手術(shù)前后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。非融合組術(shù)后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)與術(shù)前差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);融合組術(shù)后ROM(L4,5)與術(shù)前差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而ROM(L5S1)及ROM(L1S1)與術(shù)前差異有統(tǒng)計(jì)學(xué)意義(P0.05),均較術(shù)前減小。四、研究結(jié)論兩種手術(shù)方式在腰椎間盤突出癥的治療上均能取得滿意效果。髓核摘除Cosmic單側(cè)非融合內(nèi)固定與髓核摘除單側(cè)融合內(nèi)固定相比,所耗手術(shù)時(shí)間短,出血量較后者少,并且對(duì)術(shù)后相關(guān)節(jié)段和腰椎的活動(dòng)度破壞較輕。
[Abstract]:A research objective to retrospectively study the clinical curative effect of unilateral Cosmic non fusion dynamic fixation and unilateral internal fixation and fusion of two methods in the treatment of lumbar disc herniation. Two research methods from January 2010 to September 2012, 36 cases of lumbar disc herniation (L5S1) were treated with unilateral discectomy Cosmic non fusion internal fixation (18 cases) and unilateral discectomy fusion and internal fixation (18 cases) were treated surgically; non fusion group 18 cases, male 8 cases, female 10 cases, age 40-59 years, average 49 years old; fusion group 18 cases, male 11 cases, female 7 cases, age 37-60 years, average 48.5 years old. Patients underwent preoperative lateral lumbar spine and flexion extension radiographs of lumbar CT and lumbar MRI examination. A total of 36 cases of surgery, postoperative follow-up, 36 cases were followed up, including Cosmic unilateral fixation and non fusion groups were followed up for 12 to 25 months, the average follow-up time was 19.5 months unilateral internal fixation fusion group. Followed up for 12 to 26 months, the average follow-up time was 20.5 months. During the recording of the two groups in operation time, intraoperative blood loss were assessed; scores of pain in patients with preoperative and postoperative follow-up (visual analogue, scale, VAS), Oswestry disability index (Oswestry disability index, ODI) score, and compared; in the lumbar dynamic X-ray films were measured and recorded before and after the surgery at the end of the follow-up operation segment (L5S1), adjacent segment (L4,5) and lumbar (L1S1) activity (range of, motion, ROM), and statistical analysis. Three the results of the study, all patients postoperative incision stage I healing. Two groups of patients during the deadline to the end of the follow-up injury, no nerve root infection, cerebrospinal fluid leakage, recurrent disc herniation, fusion translocation and internal fixation implant loosening and other complications. The operative time and intraoperative bleeding 閲忚繘琛岀粺璁″鍒嗘瀽姣旇緝(瑙佽〃1),闈炶瀺鍚堢粍鍙?qiáng)铻嶅悎缁勻q沖潎鎵嬫湳鏃墮棿鍒嗗埆涓，

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