本文選題：微創(chuàng)TLIF　切入點(diǎn)：下位腰椎間盤突出癥　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析微創(chuàng)經(jīng)椎間孔椎體間融合術(shù)(MIS-TLIF)與開放經(jīng)椎間孔椎體間融合術(shù)(OPEN-TLIF)治療下腰椎間盤突出癥的短期臨床療效,比較兩種術(shù)式的優(yōu)、缺點(diǎn),為臨床患者選擇安全、高效的手術(shù)方式提供相關(guān)的客觀依據(jù)。方法:回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院脊柱外科2013年2月-2015年2月期間的58例單節(jié)段下腰椎間盤突出癥患者,將其分為MIS-TLIF組和OPEN-TLIF組。兩組患者均采用雙側(cè)椎弓根螺釘固定。其中30例患者行Quadrant通道輔助下微創(chuàng)經(jīng)椎間孔腰椎椎體間融合術(shù)(MIS-TLIF組),28例患者行后正中入路經(jīng)椎間孔腰椎椎體間融合術(shù)(OPEN-TLIF組)。微創(chuàng)TLIF組(MIS-TLIF):男性患者17例,女性患者13例,年齡40-85歲,平均55.7±9.2歲,病程:3個月-10年,平均20.6 個月,病變節(jié)段:L4/5:16 例,L5/SI:14 例;開放 TLIF 組(OPEN-TLIF):男性患者16例,女性患者12例,年齡38-72歲,平均55.4±8.7歲,病程:3個月-20年,平均22.1個月,病變節(jié)段:L4/5:17例,L5/S1:11例。比較兩組患者手術(shù)時間、切口長度、術(shù)中出血量、術(shù)后引流量、術(shù)后下地活動時間、術(shù)后住院時間。比較兩組在術(shù)前及術(shù)后1周、術(shù)后3個月、術(shù)后6個月、術(shù)后12個月應(yīng)用腰痛視覺模擬評分(VAS)、Oswestry功能障礙指數(shù)評分(ODI)及術(shù)后隨訪復(fù)查腰椎正側(cè)位X線觀察兩組患者椎間融合情況等。結(jié)果:所有患者隨訪至術(shù)后12～18個月,平均14.5個月。MIS-TLIF組切口長度(3.7±0.5)cm、術(shù)中出血量(153.0±22.4)ml、術(shù)后引流量(56.6±16.3)ml、術(shù)后下地活動時間(2.6±1.6)d、術(shù)后住院時間(7.5±2.7)d。OPEN-TLIF組切口長度(7.9±1.5)cm、術(shù)中出血量(351.9±54.9)ml、術(shù)后引流量(176.2±24.5)ml、術(shù)后下地活動時間(7.3±2.3)d、術(shù)后住院時間(10.9±2.6)d。MIS-TLIF組在上述方面均較OPEN-TLIF組小,兩組間差異有統(tǒng)計學(xué)意義(P0.05)。MIS-TLIF組手術(shù)時間(169.5±38.6)min較OPEN-TLIF組手術(shù)時間(150.1±27.3)min時間長,兩組間差異有統(tǒng)計學(xué)意義(P0.05)。術(shù)前兩組患者VAS評分及ODI評分差異無統(tǒng)計學(xué)意義(P0.05),MIS-TLIF組患者在術(shù)后1周、術(shù)后3個月、術(shù)后6個月的VAS評分、ODI評分均低于OPEN-TLIF組,差異有統(tǒng)計學(xué)意義(P0.05)。在術(shù)后12個月的結(jié)果顯示,患者腰痛VAS評分和ODI評分無統(tǒng)計學(xué)差異(P0.05)。術(shù)后兩組患者的腰背痛的癥狀較術(shù)前明顯好轉(zhuǎn),同一組別患者術(shù)后VAS評分、ODI評分均較術(shù)前明顯降低,差異有統(tǒng)計學(xué)意義(P0.05)。MIS-TLIF組中無相關(guān)圍手術(shù)期并發(fā)癥出現(xiàn),術(shù)中無神經(jīng)根及硬膜損傷,術(shù)后無感染、無需要輸血的患者,而OPEN-TLIF組中出現(xiàn)3例圍手術(shù)期并發(fā)癥,其中有1例患者術(shù)后出現(xiàn)暫時性根性疼痛并殘留根性麻木,3個月后完全緩解,1例患者出現(xiàn)切口深部感染,予以清創(chuàng)換藥后愈合,1例患者由于術(shù)中失血較多,給予輸血治療。術(shù)后兩組復(fù)查X線均提示內(nèi)固定物位置良好,無需二次手術(shù)。結(jié)論:MIS-TLIF和OPEN-TLIF手術(shù)相比較,具有手術(shù)創(chuàng)傷小、圍手術(shù)期并發(fā)癥少、術(shù)后疼痛輕、術(shù)后功能恢復(fù)快等優(yōu)勢,短期療效肯定,在治療下腰椎間盤突出癥疾病方面,是一種更加安全、高效的微創(chuàng)手術(shù)方法,在臨床上值得推廣使用。
[Abstract]:Objective: To study the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open transforaminal lumbar interbody fusion (OPEN-TLIF) short-term clinical curative effect of lumbar disc herniation treatment, the two groups were compared the advantages and disadvantages, and select safe for clinical patients, provide an objective basis for the relevant operation efficiency. Methods: retrospective analysis of spinal surgery, the First Affiliated Hospital of Dalian Medical University in February 2013 -2015 year in February 58 cases of single segmental lumbar disc herniation were divided into MIS-TLIF group and OPEN-TLIF group. The two groups of patients were treated by bilateral vertebral pedicle screw fixation. There were 30 patients who underwent Quadrant channel assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF group), 28 patients underwent posterior transforaminal lumbar interbody fusion (group OPEN-TLIF). Group TLIF: minimally invasive (MIS-TLIF) in 17 cases of male patients, 13 female patients, years 榫，

本文編號：1640818