本文選題：特發(fā)性脊柱側(cè)凸　切入點(diǎn)：全椎弓根螺釘　出處：《第二軍醫(yī)大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：【背景與目的】青少年特發(fā)性脊柱側(cè)凸(adolescent idiopathic scoliosis,AIS)是不明原因引起的、發(fā)生于青春發(fā)育期前后的脊柱結(jié)構(gòu)性三維畸形[1,2],這種畸形包括脊柱在冠狀面上的側(cè)凸、矢狀面上胸后凸減少或加大,胸腰段后凸或腰段前凸消失以及軸狀面上的旋轉(zhuǎn)畸形[3]。AIS是一種最常見(jiàn)的脊柱側(cè)凸畸形,在全部患者中約占80%,報(bào)道的發(fā)病率為1-3%[4,5]。目前對(duì)于輕度(Cobb40°)青少年脊柱側(cè)凸患者,一般采用支具等保守治療手段,而對(duì)于中度或重度脊柱側(cè)凸,則多選擇手術(shù)治療。后路椎弓根釘固定矯形術(shù)是應(yīng)用最廣泛的術(shù)式,獲得了良好的矯形效果。增加椎弓根螺釘置釘數(shù)量,可以增加錨定點(diǎn),提高矯形力,但同時(shí)增加了醫(yī)療成本。因此,如何應(yīng)用最少的椎弓根螺釘達(dá)到最好的脊柱側(cè)凸矯形效果,達(dá)到兩者之間的平衡?研究這一問(wèn)題對(duì)于特發(fā)性脊柱側(cè)凸患者的手術(shù)治療具有重要的臨床意義。同時(shí),特發(fā)性脊柱側(cè)凸患者不僅存在身體畸形,而且畸形的存在將嚴(yán)重影響患者的心理健康及生存質(zhì)量[3]。隨著生物-心理-社會(huì)這一新的醫(yī)學(xué)模式的出現(xiàn)及健康相關(guān)生存質(zhì)量(health-related quality of life,HRQL)研究的發(fā)展,越來(lái)越多的研究者認(rèn)識(shí)到對(duì)于脊柱側(cè)凸的治療不能單純以手術(shù)的矯正率為唯一指標(biāo),而應(yīng)以追求矯正率的提高以及患者生存質(zhì)量的改善的統(tǒng)一為最終目的[3]。然而,對(duì)于特發(fā)性脊柱側(cè)凸患者采用不同置釘密度矯形手術(shù),對(duì)其生存質(zhì)量是否具有顯著影響,目前尚缺乏相關(guān)研究。針對(duì)以上問(wèn)題,本課題擬回顧性分析在我院行后路椎弓根螺釘間隔置釘矯形的特發(fā)性脊柱側(cè)凸患者的術(shù)前、術(shù)后即刻及術(shù)后5年隨訪的影像學(xué)資料,并與全椎弓根螺釘治療患者作對(duì)比,以評(píng)估間隔置釘治療特發(fā)性脊柱側(cè)凸的手術(shù)效果;在此基礎(chǔ)上,以相同時(shí)期采用全椎弓根螺釘置釘行脊柱側(cè)凸矯形手術(shù)的患者為對(duì)照,分析采用不同矯形手術(shù)方案對(duì)患者生存質(zhì)量的影響。研究目的:1.評(píng)估對(duì)于具有良好柔韌性的特發(fā)性脊柱側(cè)凸患者采用椎弓根螺釘間隔置釘三維矯形術(shù)后隨訪五年以上手術(shù)療效。2.探討間隔置釘與全椎弓根螺釘置釘治療特發(fā)性脊柱側(cè)凸患者對(duì)其生存質(zhì)量評(píng)分差異并分析其原因�！静牧吓c方法】1.對(duì)51例側(cè)凸角度75°,柔韌度40%的特發(fā)性脊柱側(cè)凸患者,應(yīng)用椎弓根螺釘間隔置釘行脊柱側(cè)凸三維矯形手術(shù),分析其術(shù)前、術(shù)后即刻及末次隨訪時(shí)主彎Cobb角、頂椎旋轉(zhuǎn)度、冠狀面整體平衡、矢狀面平衡等影像學(xué)參數(shù),以及手術(shù)時(shí)間、術(shù)中失血量、術(shù)中/術(shù)后并發(fā)癥等相關(guān)圍手術(shù)期情況。2.特發(fā)性脊柱側(cè)凸患者被分成兩組(全釘組和間隔置釘組),其中間隔置釘組26例,全釘組20例,平均隨訪時(shí)間5.1年。兩組患者在性別、年齡、術(shù)前主彎Cobb角、主彎所在節(jié)段、手術(shù)矯正率、術(shù)后隨訪時(shí)間等方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),間隔置釘組手術(shù)費(fèi)用,術(shù)中出血量明顯低于全釘組(P0.05)。采用我單位于國(guó)際上率先引用并進(jìn)行文化調(diào)適的“簡(jiǎn)體中文版脊柱側(cè)凸研究會(huì)-22量表”(SRS-22)作為生存質(zhì)量評(píng)估所有患者均填寫(xiě)中文版,比較兩組間量表單個(gè)維度和項(xiàng)目得分的差異,分析兩組患者術(shù)前、術(shù)后及末次隨訪時(shí)生存治療評(píng)價(jià)�！窘Y(jié)果】1.主胸彎側(cè)凸Cobb角由術(shù)前53.6°±6.6°矯正為15.8°±7.4°,末次隨訪為17.7°±6.1°;頂椎旋轉(zhuǎn)由術(shù)前21.4°±7.1°矯正為9.6°±3.0°,末次隨訪時(shí)為11.0°±3.3°;冠狀面C7鉛垂線與骶正中線距離術(shù)前、術(shù)后即刻及末次隨訪分別為-6.3mm±11.2mm、-3.7mm±8.0mm、-3.9mm±5.5mm;矢狀面C7鉛垂線與S1椎體后上緣距離術(shù)前、術(shù)后即刻及末次隨訪分別為-13.3mm±10.7mm、-2.1 mm±5.2mm、-2.9mm±5.0mm。患者側(cè)凸Cobb角、頂椎旋轉(zhuǎn)、冠狀面及矢狀面平衡術(shù)前、術(shù)后比較均有顯著性差異(P0.05=,末次隨訪與術(shù)后相比無(wú)顯著性差異(P0.05)。術(shù)后2例患者發(fā)生了內(nèi)固定失敗,3例出現(xiàn)附加現(xiàn)象,1例發(fā)生傷口表淺感染。術(shù)中平均失血量為825ml,手術(shù)時(shí)間為155min。與常規(guī)手術(shù)策略相比,本組患者椎弓根螺釘置釘數(shù)量減少52%。2.兩組患者各自術(shù)前與術(shù)后即刻、術(shù)后五年隨訪組內(nèi)評(píng)分在5個(gè)維度均有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后即刻與術(shù)后五年隨訪得分在疼痛維度有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。而兩組間比較得分在術(shù)后即刻與術(shù)后五年滿意度維度有顯著統(tǒng)計(jì)學(xué)差異(P0.05)�！窘Y(jié)論】1.對(duì)于側(cè)凸角度75°,柔韌度40%的特發(fā)性脊柱側(cè)凸患者,采用椎弓根螺釘間隔置釘可獲得與常規(guī)矯形側(cè)連續(xù)置釘相似的手術(shù)療效,并可明顯縮短手術(shù)時(shí)間、減少術(shù)中失血,降低手術(shù)費(fèi)用。2.經(jīng)過(guò)中遠(yuǎn)期隨訪,采用間隔置釘手術(shù)患者在健康相關(guān)生存質(zhì)量評(píng)分中與術(shù)前評(píng)分有顯著差異,而與全椎弓根螺釘相比,兩組患者生存治療評(píng)價(jià)無(wú)顯著差異,而術(shù)后滿意度明顯高于全釘組,肯定了間隔置釘矯形手術(shù)的中遠(yuǎn)期療效,是手術(shù)治療特發(fā)性脊柱側(cè)凸的發(fā)展方向。
[Abstract]:[Objective] background with adolescent idiopathic scoliosis (adolescent idiopathic, scoliosis, AIS) is of unknown cause, occurs in the puberty before and after spinal [1,2] 3D structural deformity, this deformity including scoliosis in the coronal plane, sagittal thoracic kyphosis on the decrease or increase of thoracolumbar kyphosis or the lumbar lordosis disappeared and rotational deformity of [3].AIS axis on the plane is one of the most common scoliosis deformity in all patients, about 80% of the total reported incidence rate of 1-3%[4,5]. for mild (Cobb40 degree) of adolescent scoliosis patients, generally use the brace conservative treatment, and for moderate or severe scoliosis is surgical treatment. Posterior pedicle screw fixation surgery is the most widely used and achieved good corrective effects. Increasing the number of pedicle screw placement, can increase the anchor point,. High orthopedic force, but also increases the cost of medical care. Therefore, how to use the pedicle screw to reach at least scoliosis had the best effect, to achieve the balance between the two? This issue has important clinical significance for surgical treatment of patients with idiopathic scoliosis. Meanwhile, idiopathic scoliosis patients not only exist physical deformities, and deformity seriously affect the patient's psychological health and quality of life of [3]. with bio psycho social this new medical model and health related quality of life (health-related quality of life, HRQL) research and development, more and more researchers recognize the scoliosis treatment not only to surgical correction was the only indicator, and should be unified in pursuit of the correction rate increase and improve the quality of life of the patients for the ultimate goal of [3]. however, for idiopathic Patients with scoliosis with different implant density in orthopedic surgery, whether the quality has a significant impact on its survival, there is still lack of study. To solve the above problems, this paper analyzed retrospectively in our hospital underwent posterior pedicle screw placement interval correction of idiopathic scoliosis patients before surgery, immediately after surgery and after surgery 5 year follow-up imaging data, and compared with the pedicle screw fixation for the treatment of patients, to evaluate the effect of operation interval pedicle screw fixation for the treatment of idiopathic scoliosis; on this basis, at the same time using pedicle screw fixation for spinal scoliosis surgery patients as the control, analysis of influence by different orthopedic surgery program on the quality of life of patients. Objective: 1. has a good flexibility assessment for the patients with idiopathic scoliosis with pedicle screw placement interval three-dimensional orthopedic patients were followed up for five years to get started To investigate the curative effect of.2. interval pedicle screws and pedicle screw placement for the treatment of idiopathic scoliosis patients quality of life scores on the difference and analysis of its causes. [materials and methods] 1. to 51 cases of scoliosis angle of 75 degrees, the flexibility of the 40% patients with idiopathic scoliosis, pedicle screw placement for spinal spacer the three-dimensional analysis of the scoliosis orthopedic surgery, preoperative, postoperative and the last follow-up when the main bending angle Cobb, apical vertebral rotation, the overall balance of the coronal, sagittal balance parameter imaging, and the operation time, intraoperative blood loss, intraoperative complications during the perioperative period of.2. idiopathic scoliosis patients were divided into two groups (the entire nail group and interval nailing group), the interval of nailing group in 26 cases, the entire nail group 20 cases, the average follow-up time of 5.1 years. The two groups in gender, age, preoperative main bending angle Cobb, where the main bending section, surgery the postoperative correction rate, with the 璁挎椂闂寸瓑鏂歸潰鏃犵粺璁″宸紓(P0.05),闂撮殧緗拤緇勬墜鏈垂鐢，

本文編號(hào)：1636615