本文選題：老年　切入點：腰椎退行性疾病　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:據(jù)世界人口統(tǒng)計學(xué)顯示,2015年,年齡大于65歲的老年人群人口數(shù)量可達6億,2020年預(yù)計突破7億,全球人口呈現(xiàn)老齡化轉(zhuǎn)變。年齡和病理狀態(tài)會降低脊柱后縱韌帶彈性蛋白含量、軀干、腰背肌肌肉力量及脊柱骨密度,可引起纖維環(huán)破裂、髓核脫出、椎間隙高度丟失、黃韌帶增生肥厚,小關(guān)節(jié)增生等腰椎退變,增加腰椎退行性疾病的發(fā)病率,導(dǎo)致下肢與軀干部功能障礙,影響患者的生活質(zhì)量。目前,治療腰椎退行性疾病的手術(shù)方案呈現(xiàn)多樣化。其中,腰椎椎間融合術(shù)可以有效緩解疼痛并恢復(fù)脊柱的生理序列,提高穩(wěn)定性,縮短患者臥床天數(shù),被認為是治療腰椎退行性疾病的有效術(shù)式。近年來,外科技術(shù)的發(fā)展呈現(xiàn)微創(chuàng)化與智能化,在脊柱外科領(lǐng)域,微創(chuàng)技術(shù)得到迅猛發(fā)展,新技術(shù)層出不窮,適應(yīng)范圍逐漸擴大,微創(chuàng)椎間融合術(shù)MIS-TLIF術(shù)式發(fā)展迅猛。雖然老年人群有其特殊性,合并基礎(chǔ)疾病數(shù)量多,平均身體素質(zhì)差,傳統(tǒng)觀點認為老年人行脊柱手術(shù)所伴發(fā)的圍手術(shù)期風(fēng)險較高,但也有學(xué)者提出大于大于70歲或80歲的老年患者行椎間融合術(shù)效果可觀,手術(shù)安全性較高。本文旨在通過比較75歲以上腰椎退行性疾病患者行PLIF與MIS-TLIF的手術(shù)療效,以對日后高齡群體患者行手術(shù)治療提供臨床指導(dǎo)意見。目的:探討傳統(tǒng)開放后路腰椎椎間融合術(shù)(posterior lumbar interbody fusion,PLIF)與Quadrant擴張通道輔助的微創(chuàng)經(jīng)椎間孔入路腰椎椎間融合術(shù)(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治療75歲以上患單節(jié)段腰椎退行性疾病(包括腰椎間盤突出癥、腰椎管狹窄癥、腰椎滑脫癥等)的老年患者的臨床療效。方法:回顧性研究2013年1月至2016年1月于本院同一醫(yī)療組行單節(jié)段腰椎椎間融合內(nèi)固定術(shù)且符合條件的48例患者,其中男性患者29例,女性患者19例,包括腰椎間盤突出癥19例,腰椎管狹窄癥21例,II度以內(nèi)腰椎滑脫8例,所有患者年齡均大于75歲,平均年齡為76.9歲,平均病程為64.7個月。結(jié)合臨床癥狀、體格檢查及腰椎正側(cè)位、腰椎過伸過屈位X線、腰椎CT和腰椎MRI等影像檢查。其中26例患者行PLIF手術(shù),余22例行經(jīng)Quadrant通道下的MIS-TLIF手術(shù)。比較兩組患者的年齡、性別、病程、手術(shù)節(jié)段、基礎(chǔ)疾病的數(shù)目、術(shù)前腰腿痛VAS評分、腰椎JOA評分,差異無統(tǒng)計學(xué)意義(P0.05)。對PLIF組與MIS-TLIF組的臨床療效(腰腿痛VAS評分及腰椎JOA評分)、術(shù)中出血量、術(shù)后引流量、臥床天數(shù)、住院日等圍手術(shù)期相關(guān)指標與并發(fā)癥發(fā)生率等方面進行對比,分析兩種術(shù)式對于老年患者群體的臨床療效。結(jié)果:MIS-TLIF組與傳統(tǒng)PLIF組患者的術(shù)后腰腿痛VAS評分與腰椎JOA評分與術(shù)前的差異有統(tǒng)計學(xué)意義(P0.05);術(shù)后3d和3個月的腰腿痛VAS評分MIS-TLIF組較低(P0.05);術(shù)后隨訪1年,兩組患者腰腿痛VAS評分及腰椎JOA評分無統(tǒng)計學(xué)差異(P0.05);與傳統(tǒng)PLIF組相比,MIS-TLIF組的術(shù)中出血量、術(shù)后引流量、臥床天數(shù)、住院日等均有改善(P0.05),但手術(shù)時間也更長(P0.05)。MIS-TLIF組術(shù)后并發(fā)癥2例(9.1%),PLIF組6例(23.1%),組間無統(tǒng)計學(xué)差異(P0.05),組間術(shù)后融合率也無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:MIS-TLIF與PLIF手術(shù)對75歲以上老年患者的臨床療效值得肯定,均能明顯改善患者癥狀,且兩種術(shù)式能取得相同的臨床療效;MIS-TLIF術(shù)式圍手術(shù)期出血量較少、術(shù)后臥床天數(shù)及住院日縮短、短期腰背疼痛較輕,對老年患者有創(chuàng)傷小、恢復(fù)快等優(yōu)勢。
[Abstract]:Objective: according to the statistics in 2015, the world's population, age older than 65 year old population number is 600 million, 2020 is expected to exceed 700 million, the global population aging presents change. Age and pathological conditions will reduce the longitudinal ligament elastin, posterior trunk, back muscle muscle strength and bone density, can cause fiber ring rupture of nucleus pulposus, loss of intervertebral height, yellow ligament hypertrophy, hyperplasia of lumbar facet joint degeneration, increase the incidence of lumbar degenerative disease rate, resulting in lower limb and trunk dysfunction, affecting the quality of life of the patients. At present, surgical treatment of lumbar degenerative disease. The diversification of the lumbar interbody fusion can effectively relieve pain and restore the spinal physiological sequence, improve stability, shorten the patients bed days, is considered to be effective for the treatment of lumbar degenerative disease in recent years. To show the development of surgical techniques, minimally invasive and intelligent, in spinal surgery, minimally invasive technique has been the rapid development of new technology emerge in an endless stream, gradually expanding the scope of adaptation, interbody fusion MIS-TLIF surgery is minimally invasive. Although the rapid development of the elderly population has its particularity, the average number of underlying diseases, poor physical quality, traditional view elderly patients undergoing spinal surgery are associated with a higher risk of peri operative period, but also some scholars proposed greater than 70 years or 80 year old elderly patients with lumbar fusion effect is considerable, the operation safety is high. The purpose of this paper is in surgery by comparing the above 75 years old of lumbar degenerative disease were treated with PLIF and MIS-TLIF, to provide clinical guidelines for the age group of patients with surgical treatment day. Objective: To explore the traditional open posterior lumbar interbody fusion (posterior lumbar interbody fusion, PLIF and Quadrant) The expansion channel assisted minimally invasive transforaminal lumbar interbody fusion (minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF) in patients over 75 years of suffering from lumbar degenerative diseases (including lumbar disc herniation, lumbar spinal stenosis, lumbar slipping disease) clinical efficacy in elderly patients. Methods: a retrospective review study from January 2013 to January 2016 in our hospital with a medical group for 48 cases of single segmental lumbar interbody fusion and internal fixation and meet the conditions of the patients, including 29 cases of male patients, 19 female patients, including 19 cases of lumbar disc herniation, 21 cases of lumbar spinal stenosis, II degrees of lumbar spondylolisthesis in 8 cases, all the age of the patients was 75 years, the average age is 76.9, the average duration of 64.7 months. According to the clinical symptoms, physical examination and lumbar vertebrae, lumbar radiographs, lumbar CT and lumbar spine MRI examinations. In 26 patients who underwent PLIF surgery, more than 22 cases by Quadrant channel under MIS-TLIF operation. The two groups were comparable in age, gender, disease duration, surgical segment, the number of basic diseases, preoperative leg pain VAS score, lumbar JOA score, the difference was not statistically significant (P0.05). The clinical curative effect of PLIF group group MIS-TLIF (low back pain VAS score and lumbar JOA score), intraoperative bleeding, postoperative drainage, hospitalization days and bed days, around the relevant indicators and perioperative incidence were compared, analysis of two operative methods for the clinical efficacy of community elderly patients. Results: there was significant difference in waist and leg the pain VAS score and lumbar JOA score and preoperative patients in the MIS-TLIF group and the traditional group PLIF after operation (P0.05); low back pain VAS score after operation in MIS-TLIF group and 3 months in 3D low (P0.05); after 1 years follow-up, two patients of lumbar and leg pain VAS score and lumbar JOA score Statistical difference (P0.05); compared with PLIF group, MIS-TLIF group of intraoperative bleeding, postoperative drainage, bed days, hospitalization days were improved (P0.05), but the operation time is longer (P0.05) in 2 cases of postoperative complications of group.MIS-TLIF (9.1%), PLIF group of 6 cases (23.1%). There was no significant difference between groups (P0.05 group), postoperative fusion rate had no significant difference (P0.05). Conclusion: the clinical efficacy of MIS-TLIF and PLIF surgery for elderly patients over 75 years of age should be affirmed, can significantly improve the symptoms of patients, and two kinds of operation can achieve the same clinical efficacy; MIS-TLIF operation perioperative less bleeding, postoperative bed days and hospitalization days, short-term pain is light, for elderly patients with small trauma, quick recovery and other advantages.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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