本文選題：PELD　切入點(diǎn)：L5-S1椎間盤突出　出處：《浙江大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本研究的目的是通過比較已行TF-PELD和IL-PELD治療的L5-S1椎間盤突出患者的影像學(xué)特征和治療效果,來闡述L5-S1椎間盤突出患者PELD手術(shù)通路的選擇標(biāo)準(zhǔn)。方法：對在我院行TF-PELD和IL-PELD治療的50位L5-S1椎間盤突出病人進(jìn)行回顧性分析,術(shù)前術(shù)后均行MRI及X線片檢查。對椎間盤類型、大小、位置、是否遷移、椎間盤高度、椎間孔高度、髂骨高度和椎板間高度進(jìn)行比較分析。對隨訪時間滿1年的患者予量表收集評估臨床療效。術(shù)前術(shù)后均采用疼痛視覺類比評分(visual analogue scale,VAS)來測量評估患者疼痛,用Oswestry功能障礙指數(shù)(oswestry disability index,ODI)和回歸工作時間間隔來評估患者功能情況。結(jié)果：兩組病人術(shù)后VAS評分和ODI評分較術(shù)前都有顯著性提高,而兩組間腰背部和腿部VAS評分以及ODI評分比較都沒有顯著性差異.TF-PELD組平均回歸工作間隔時間為4.7±2.4周,IL-PELD組為4.2±1.5周。1年隨訪結(jié)果顯示,TF-PELD組無一病人出現(xiàn)腰椎間盤復(fù)發(fā)、感覺異常或出行神經(jīng)損傷癥狀,而IL-PELD組有1位病人復(fù)發(fā),并且有2位病人出現(xiàn)術(shù)后局部感覺異常。兩組病人回歸工作時間、復(fù)發(fā)率相比都無顯著性差異。TF-PELD和IL-PELD兩組間在椎間盤類型、移位程度和椎間盤位置等方面具有顯著性差異。在IL-PELD組中,腋下型椎間盤比例(17例,68%)高于肩上型(8例,32%)。另一方面,TF-PELD組肩上型(18例,72%)發(fā)病率比腋下型(7例,28%)高(P=0.01)。TF-PELD組(8例,32%)的中央型椎間盤突出發(fā)病率比IL-PELD組(2例,8%)高(P=0.01)。9例(36%)高度移位病例接受了IL-PELD,而只有1(4%)例行TF-PELD(P=0.01)。2例復(fù)發(fā)性腰椎間盤突出病人成功行TF-PELD取出突出的椎間盤。反應(yīng)髂骨和L5-S1椎間盤解剖關(guān)系的影像學(xué)指標(biāo)在兩組間均無顯著性差異。結(jié)論：該研究表明TF—PELD對于肩上型、中央型和復(fù)發(fā)的腰椎間盤突出療效更好,而IL-PELD對腋下型和游離型突出椎間盤具有優(yōu)勢,對于遷移程度高的游離型突出椎間盤來說,IL-PELD比TF-PELD更為適合。
[Abstract]:Objective: to compare the imaging features and therapeutic effects of L5-S1 disc herniation patients who have been treated with TF-PELD and IL-PELD. Methods: 50 patients with L5-S1 disc herniation treated by TF-PELD and IL-PELD in our hospital were analyzed retrospectively. MRI and X-ray examination were performed before and after operation. Size, location, migration, disc height, intervertebral foramen height, The height of iliac bone and the height of vertebral lamina were compared and analyzed. The clinical curative effect was evaluated by collecting and evaluating the clinical efficacy of the patients who had been followed up for more than one year. The pain was evaluated by visual analogue scale scale before and after operation. The functional status of patients was evaluated by Oswestry dysfunction index (Oswestry) and regression time interval. Results: the VAS score and ODI score of the two groups were significantly higher than those before operation. However, there was no significant difference in VAS score and ODI score between the two groups. The average regression interval was 4.7 鹵2.4 weeks in the TF-PELD group and 4.2 鹵1.5 weeks in the IL-PELD group. The results of 1-year follow-up showed that none of the patients in the TF-PELD group had recurrence of lumbar intervertebral disc. In the IL-PELD group, 1 patient recurred and 2 patients had postoperative local sensory abnormalities. The patients in both groups returned to work time. There was no significant difference in recurrence rate between TF-PELD and IL-PELD. There were significant differences in disc type, displacement and disc location between TF-PELD and IL-PELD groups. The incidence of central disc herniation in the TF-PELD group was higher than that in the TF-PELD group (n = 8). The incidence of central disc herniation in the TF-PELD group was higher than that in the IL-PELD group (n = 2, n = 8). On the other hand, the incidence of central disc herniation in the TF-PELD group was higher than that in the TF-PELD group (n = 18, n = 18, n = 72). The incidence of central disc herniation in the TF-PELD group was higher than that in the TF-PELD group (n = 8). The patients with degree shift received IL-PELDD, but only 1 out of 4 patients were treated with TF-PELD(P=0.01).2. Patients with recurrent lumbar intervertebral disc herniation were successfully removed by TF-PELD. There was no significant difference in the imaging parameters of the anatomical relationship between iliac bone and L5-S1 disc in both groups. Conclusion: this study shows that TF-PELD is associated with shoulder type, Central and recurrent lumbar disc herniation were more effective, while IL-PELD had advantages in axillary and free intervertebral disc herniation, and IL-PELD was more suitable for free disc herniation with high migration degree than TF-PELD.
【學(xué)位授予單位】：浙江大學(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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