本文選題：腰椎滑脫癥　切入點(diǎn)：術(shù)后療效　出處：《寧夏醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的采用Logistic回歸分析篩選出可能影響腰椎滑脫癥手術(shù)療效的危險(xiǎn)因素,為今后臨床上治療腰椎滑脫癥選擇手術(shù)時(shí)機(jī)和手術(shù)方案提供參考依據(jù)和指導(dǎo),同時(shí)為進(jìn)一步研究影響腰椎滑脫癥遠(yuǎn)期療效的相關(guān)因素奠定基礎(chǔ)。方法采用回顧-前瞻性隊(duì)列研究方法,以2007年-2012年六年期間因腰椎滑脫癥在寧夏醫(yī)科大學(xué)總醫(yī)院脊柱骨科行手術(shù)治療的患者為研究對(duì)象,通過醫(yī)院病案系統(tǒng),收集患者的術(shù)前資料,通過門診及電話隨訪收集患者的術(shù)后情況,按照統(tǒng)一的調(diào)查表對(duì)患者進(jìn)行隨訪、調(diào)查。調(diào)查的內(nèi)容包括:性別、年齡、體重指數(shù)、滑脫節(jié)段、滑脫的類型、滑脫程度、病程的長短、術(shù)前JOA評(píng)分、術(shù)前椎間高度比值、手術(shù)方式、減壓范圍、融合方式、是否使用Cage、術(shù)后即刻復(fù)位率、末次隨訪復(fù)位丟失率、末次隨訪椎間高度比值,將這些可能影響臨床療效的相關(guān)因素作為自變量。通過末次隨訪及術(shù)前JOA評(píng)分,計(jì)算好轉(zhuǎn)率,并以此作為臨床療效的判斷指標(biāo),將其進(jìn)行二分類變量處理,分為療效優(yōu)良組(好轉(zhuǎn)率50%)及療效欠佳組(好轉(zhuǎn)率≤50%)。通過t檢驗(yàn)(計(jì)量資料)或χ2檢驗(yàn)(計(jì)數(shù)資料)對(duì)所有自變量進(jìn)行單因素分析,以P0.05為水準(zhǔn),篩選出可能影響手術(shù)療效的危險(xiǎn)因素。然后將篩選出的自變量進(jìn)行非條件Logistic回歸分析。結(jié)果最終獲得隨訪且數(shù)據(jù)收集完整的病例126份,其中男85例,女41例,平均年齡51.15±9.54(26-76)歲,平均隨訪時(shí)間46(24-86)月。術(shù)后療效:優(yōu):20例,良:79例,中:23例,差:4例,優(yōu)良率為78.6%。單因素分析結(jié)果顯示:體重指數(shù)、術(shù)前JOA評(píng)分、末次隨訪椎間高度比值、術(shù)后滑脫復(fù)位率對(duì)腰椎滑脫癥手術(shù)療效的影響有統(tǒng)計(jì)學(xué)意義(PO.05);再次進(jìn)行二分類Logistic多因素回歸分析,其結(jié)果顯示:術(shù)前JOA評(píng)分對(duì)手術(shù)療效的影響有統(tǒng)計(jì)學(xué)意義(PO.05)。結(jié)論1、性別、年齡、體重指數(shù)、滑脫節(jié)段、滑脫的類型、滑脫程度、病程的長短、術(shù)前椎間高度比值、手術(shù)方式、減壓范圍、植骨方式、是否使用Cage、術(shù)后滑脫復(fù)位率、末次隨訪滑脫復(fù)位率丟失率、末次隨訪椎間高度比值對(duì)腰椎滑脫癥手術(shù)療效的影響沒有統(tǒng)計(jì)學(xué)意義。2、患者術(shù)前JOA評(píng)分對(duì)手術(shù)療效的影響是有統(tǒng)計(jì)學(xué)差異的。本研究探討發(fā)現(xiàn),術(shù)前JOA評(píng)分是術(shù)后療效的保護(hù)性因素,術(shù)前JOA評(píng)分越高,其術(shù)后療效相對(duì)越好。3、手術(shù)方式的選擇要根據(jù)患者癥狀、體征及影像學(xué)檢查做到個(gè)性化處理,在減壓、復(fù)位、固定融合等幾個(gè)步驟要略有側(cè)重。
[Abstract]:Objective to screen out the risk factors of lumbar spondylolisthesis by Logistic regression analysis, and to provide reference and guidance for the choice of surgical timing and surgical scheme for lumbar spondylolisthesis in the future.It also lays a foundation for further study of the related factors affecting the long-term outcome of lumbar spondylolisthesis.Methods retrospective prospective cohort study was performed on patients with lumbar spondylolisthesis who underwent surgical treatment in the Department of Spinal Orthopaedics, General Hospital of Ningxia Medical University, from 2007 to 2012.The preoperative data were collected and the postoperative data were collected through outpatient and telephone follow-up. The patients were followed-up and investigated according to the unified questionnaire.The contents of the survey included gender, age, body mass index, slip segment, type of slippage, degree of slippage, duration of disease, preoperative JOA score, preoperative intervertebral height ratio, surgical procedure, range of decompression, fusion.Whether Cagewas used, the rate of immediate reduction after operation, the rate of lost reduction at the last follow-up, and the ratio of intervertebral height at the last follow-up were taken as independent variables.According to the last follow-up and preoperative JOA score, the improvement rate was calculated and used as an index to judge the clinical curative effect. The patients were divided into two groups: good effect group (improvement rate 50) and poor effect group (improvement rate 鈮，

本文編號(hào)：1711625