本文選題：腰椎間盤突出髓核摘除術(shù)　切入點(diǎn)：單側(cè)Cage　出處：《延安大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的對(duì)比單側(cè)與雙側(cè)CAGE在腰椎間盤突出髓核摘除術(shù)中的臨床應(yīng)用效果與安全性。方法1.按照連續(xù)入組的方式選擇需手術(shù)治療的腰椎間盤突出患者100例,按照入院病歷尾號(hào)奇偶數(shù)分為觀察組與對(duì)照組,每組50例。2.兩組患者均采用腰椎后路減壓植骨融合內(nèi)固定術(shù),觀察組采用單側(cè)Cage術(shù)式,對(duì)照組采用雙側(cè)Cage術(shù)式。3.兩組患者術(shù)后每月進(jìn)行電話隨訪一次,詢問患者自我感覺,根據(jù)患者對(duì)術(shù)后自身恢復(fù)情況確定來院檢查時(shí)間,無(wú)特殊情況發(fā)生者,均要求患者術(shù)后1、3、6、12、18個(gè)月來院接受檢查。4.觀察指標(biāo):①比較兩組患者平均手術(shù)時(shí)間、術(shù)中出血量、術(shù)后臥床時(shí)間、住院時(shí)間及治療費(fèi)用;②根據(jù)疼痛視覺模擬評(píng)分法(the efficacy was assessed using visual analog scores,VAS)[14],比較兩組患者術(shù)前、術(shù)后VAS評(píng)分及術(shù)后VAS評(píng)分優(yōu)良率;③根據(jù)漢化Oswestry功能障礙指數(shù)評(píng)價(jià)表(Oswestry disability index,ODI)評(píng)估兩組患者術(shù)前、術(shù)后ODI評(píng)分情況,比較ODI評(píng)分優(yōu)良率和ODI評(píng)分;④兩組患者術(shù)后1、3、6、12、18個(gè)月拍攝腰椎正側(cè)位及過伸過屈動(dòng)力位X線片,測(cè)量術(shù)后椎間隙高度,與術(shù)前進(jìn)行比較;⑤通過CT掃描確定兩組患者術(shù)后6個(gè)月、12個(gè)月Cage融合度。⑥比較兩組患者術(shù)后并發(fā)癥發(fā)生率。5.所得數(shù)據(jù)應(yīng)用醫(yī)學(xué)統(tǒng)計(jì)軟件SPSS19.0進(jìn)行分析,計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(X±S)表示,組間采用t檢驗(yàn),多時(shí)點(diǎn)重復(fù)觀測(cè)資料采用單因素重復(fù)測(cè)量方差分析;計(jì)數(shù)資料應(yīng)用χ2檢驗(yàn),P0.05表示有統(tǒng)計(jì)學(xué)意義。結(jié)果1.觀察組患者較對(duì)照組平均手術(shù)時(shí)間短、術(shù)中出血量少、術(shù)后臥床時(shí)間短、住院費(fèi)用低,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.觀察組患者術(shù)后1個(gè)月VAS評(píng)分、ODI評(píng)分低于對(duì)照組,兩組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后3、6、12、18個(gè)月兩組患者VAS評(píng)分、ODI評(píng)分無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),觀察組患者術(shù)后1個(gè)月VAS評(píng)分、ODI評(píng)分優(yōu)良率為87.23%。高于對(duì)照組的76.09%,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組患者術(shù)后1、3、6、12個(gè)月兩組患者椎間隙高度依次減低,但術(shù)后6個(gè)月后椎間隙穩(wěn)定,術(shù)后12、18個(gè)月與術(shù)后6個(gè)月比較椎間隙高度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者術(shù)后1、3、6、12、18個(gè)月椎間隙高度比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.觀察組患者術(shù)后6個(gè)月椎體融合率為82.98%,低于對(duì)照組的93.48%,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),觀察組術(shù)后12個(gè)月椎體融合率為97.87%,低于對(duì)照組的100%,但比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5.兩組患者術(shù)后均無(wú)并發(fā)癥發(fā)生。結(jié)論1.單側(cè)Cage治療椎間盤突出手術(shù)創(chuàng)傷小,有助于早期康復(fù),減少治療費(fèi)用。2.單側(cè)Cage治療椎間盤突出術(shù)后早期疼痛輕,遠(yuǎn)期疼痛改善可取得雙側(cè)Cage效果。3.單側(cè)Cage治療椎間盤突出術(shù)后早期腰椎生理功能改善優(yōu)于雙側(cè)Cage,遠(yuǎn)期腰椎生理功能改善與雙側(cè)Cage無(wú)異。4.單側(cè)Cage治療椎間盤突出在改善椎間隙方面,可取的雙側(cè)Cage的臨床效果。5.單側(cè)Cage治療椎間盤突出術(shù)后6個(gè)月椎體融合率略低于雙側(cè)Cage,但遠(yuǎn)期融合率無(wú)異。6.單側(cè)Cage治療椎間盤突出安全性較高。
[Abstract]:Objective to compare the unilateral and bilateral CAGE in lumbar discectomy and the clinical effect and safety of surgery. 100 cases of disc herniation patients need surgical treatment according to the selection method of 1. consecutive group means of lumbar, according to the medical records of the tail number of odd number is divided into observation group and control group, each group of 50 cases of.2. two groups of patients were treated with posterior lumbar interbody fusion surgery, observation group were treated with unilateral Cage surgery, the control group with bilateral Cage surgery.3. two group patients were followed up once a month, ask the patient feels, according to the patients for postoperative recovery to the hospital to check to determine its time, no special to happen, all patients 1,3,6,12,18 months after surgery to the hospital for examination of.4. outcome measures: the two groups were compared with the average operative time, intraoperative blood loss, postoperative bed time, hospitalization time and treatment cost; according to the pain The pain visual analogue scale (the efficacy was assessed using visual analog scores, VAS [14]), two groups of the patients were compared before and after operation VAS score and postoperative VAS score excellent rate; according to the Chinese Oswestry disability index evaluation scale (Oswestry disability index, ODI) assessment of two groups of patients before surgery, ODI score after comparison, the good rate of ODI score and ODI score; the two groups of patients after 1,3,6,12,18 months of shooting lumbar vertebrae and dynamic flexion extension radiographs, measuring the height of intervertebral space, compared with the preoperative; through CT scan identified 6 months after operation in the two groups, 12 Cage degree of integration. The comparison of two groups of patients with postoperative complication rate of.5. data from the application of medical statistical software SPSS19.0 analysis, standard deviation measurement data (X + S) said, t test were used for observation, repeated data using single factor weight Analysis of variance of repeated measurement; counting data using 2 test, P0.05 indicated statistical significance. Results of the 1. patients in the observation group compared with the control group, the average operation time is short, less bleeding, postoperative bed time is short, the cost was low, the difference was statistically significant (P0.05).2. observation group of patients after 1 VAS score, ODI score lower than the control group, with significant differences between the two groups (P0.05), 3,6,12,18 months after operation in two groups of patients with VAS score, ODI score was not statistically significant (P0.05), the observation group of patients after 1 months VAS score, 76.09% 87.23%. higher than the control group in the ODI score excellent rate, the difference was statistically significant (P0.05.3.) two groups of patients after 1,3,6,12 months of two groups of patients with intervertebral height decreased, but after 6 months after the intervertebral stability, postoperative 6 months 12,18 months and postoperative intervertebral height difference was statistically significant (P0.05); two No significant group of patients after 1,3,6,12,18 months of intervertebral height difference (P0.05) of.4. patients in the observation group after 6 months of vertebral fusion rate was 82.98%, lower than 93.48% in the control group, the difference was statistically significant (P0.05), the observation group after 12 months of vertebral fusion rate was 97.87%, 100% lower than the control group, but the difference was not statistically significant (P0.05.5.) two groups of patients without postoperative complications. Conclusion 1. unilateral Cage treatment of lumbar disc herniation surgical trauma, is helpful in the early rehabilitation, reduce the cost of treatment of unilateral.2. Cage treatment of intervertebral disc protrusion in early postoperative pain, long-term pain improvement can be achieved in bilateral the effect of Cage.3. Cage in the treatment of unilateral lumbar disc herniation postoperative lumbar physiological function was better than that of bilateral Cage, the lumbar physiological function and improve the bilateral Cage as.4. unilateral Cage treatment of lumbar disc herniation in improving intervertebral space, can be The clinical effect of bilateral Cage was.5.. The fusion rate of vertebral body was slightly lower than that of bilateral Cage at 6 months after unilateral Cage treatment, but the long-term fusion rate was different..6. unilateral Cage treatment had higher safety of intervertebral disc protrusion.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1607194