本文選題：單側(cè) + TLIF��； 參考：《青海大學(xué)》2015年碩士論文

【摘要】：目的:研究單側(cè)TLIF對外側(cè)、極外側(cè)腰椎間盤突出癥手術(shù)治療的效果,分析單側(cè)TLIF手術(shù)的優(yōu)勢與不足。方法:選取青海大學(xué)附屬醫(yī)院脊柱外科2011年3月至2014年3月期間手術(shù)治療的外側(cè)、極外側(cè)腰椎間盤突出癥患者30例;手術(shù)前進(jìn)行隨機(jī)分組,每一組各15例。單側(cè)TLIF組采取單側(cè)TLIF手術(shù)治療,PLIF組采取PLIF手術(shù)治療,所有30例手術(shù)都由同一組醫(yī)師完成。術(shù)前給予止痛、對癥治療,充分臥床休息,積極進(jìn)行保守治療。術(shù)前進(jìn)行VAS評分、JOA評分。術(shù)后抗感染、脫水、止血等對癥支持治療。根據(jù)預(yù)案對兩組術(shù)中指標(biāo)(詳見表2,表3)進(jìn)行統(tǒng)計。術(shù)后3個月隨訪進(jìn)行VAS評分、JOA評分,隨訪3月、6月、1年腰椎正側(cè)位片,評價椎間融合情況,記錄開始融合的時間。結(jié)果:與PLIF組的患者相比,單側(cè)TLIF組手術(shù)時間更短,手術(shù)出血也更少,對比差別具有統(tǒng)計學(xué)意義。臥床時間、切口長度、椎體間融合率、開始融合時間兩組進(jìn)行比較,差別無統(tǒng)計學(xué)意義(P0.05)。采用單側(cè)TLIF手術(shù)治療的患者手術(shù)時間116.5±13.2min、術(shù)中出血量247.3±46.8ml、手術(shù)切口7.09±0.1cm、臥床時間4.4±0.83d;開始融合時間3.8±1.12 month,融合率80.00%。PLIF組手術(shù)時間180.0±20.9min、術(shù)中出血量454.6±56.9ml、手術(shù)切口長度7.12±0.2cm、臥床時間4.6±0.81,椎體間融合時間4.0±1.36month,融合率86.67%。術(shù)后3月統(tǒng)計療效,單側(cè)TLIF組和PLIF組的療效分別為80.0%和73.3%,比較差別無統(tǒng)計學(xué)意義(P0.05)。單側(cè)TLIF組VAS評分術(shù)前7.71±0.62分,術(shù)后2.30±0.84分,改善率(70.63±8.6)%,JOA評分術(shù)前11.86±2.1分,術(shù)后20.80±3.5分,改善率(75.2±8.6)%。PLIF組VAS術(shù)前8.26±0.56分、術(shù)后2.41±0.71分,改善率(71.31±8.1)%,JOA術(shù)前11.93±1.8分,術(shù)后20.86±3.5分,改善率(74.8±9.6)%。單側(cè)TLIF與PLIF組手術(shù)前VAS、JOA評分和術(shù)后3月隨訪的評分對比其差別均無統(tǒng)計學(xué)意義((P0.05);結(jié)論:單側(cè)TLIF和PLIF手術(shù)相比較,其手術(shù)出血少,手術(shù)時間短,是一種治療外側(cè)、極外側(cè)腰椎間盤突出癥更加安全、可靠的術(shù)式。
[Abstract]:Objective: to study the effect of unilateral TLIF on lateral and extreme lateral lumbar disc herniation and to analyze the advantages and disadvantages of unilateral TLIF.Methods: thirty patients with lateral and far lateral lumbar disc herniation were selected from spinal surgery department of Qinghai University affiliated Hospital from March 2011 to March 2014.Unilateral TLIF group was treated with unilateral TLIF operation. All 30 cases of PLIF operation were performed by the same group of physicians.Preoperative pain relief, symptomatic treatment, full bed rest, active conservative treatment.VAS score and JOA score were performed before operation.Postoperative anti-infection, dehydration, hemostasis and other symptomatic support treatment.Two groups of intraoperative indexes (see Table 2 and Table 3 for details) were counted according to the plan.The VAS score was followed up for 3 months. The anterior and lateral lumbar vertebrae were followed up for 3 months, 6 months and 1 year to evaluate the intervertebral fusion and to record the time when fusion began.Results: compared with PLIF group, unilateral TLIF group had shorter operation time and less bleeding.The time of bed rest, length of incision, fusion rate between vertebrae and fusion time between the two groups were compared. There was no significant difference between the two groups (P 0.05).The operation time of unilateral TLIF was 116.5 鹵13.2 minutes, the intraoperative bleeding was 247.3 鹵46.8 ml, the incision was 7.09 鹵0.1 cm, the bed-rest time was 4.4 鹵0.83 days, the fusion time was 3.8 鹵1.12 monthth.The fusion rate was 180.0 鹵20.9 min, the intraoperative bleeding was 454.6 鹵56.9 ml, the incision length was 7.12 鹵0.2 cm, the bed-rest time was 4.6 鹵0.81, and the vertebrae fusion time was 3.8 鹵1.12month.The operative incision length was 7.12 鹵0.2cm, and the bed-rest time was 4.6 鹵0.81in the 80.00%.PLIF group.The interbody fusion time was 4.0 鹵1.36 month.The fusion rate was 86.67.Three months after operation, the curative effect of unilateral TLIF group and PLIF group were 80.0% and 73.3%, respectively. There was no significant difference between the two groups (P 0.05).The VAS score of unilateral TLIF group was 7.71 鹵0.62 before operation, 2.30 鹵0.84 after operation. The improvement rate was 11.86 鹵2.1 before operation and 20.80 鹵3.5 after operation. The improvement rate was 8.26 鹵0.56 before VAS and 2.41 鹵0.71 in 8.6)%.PLIF. The improvement rate was 11.93 鹵1.8 before operation and 20.86 鹵3.5 after operation. The improvement rate was 74.8 鹵9.6B.There was no significant difference between unilateral TLIF and PLIF before operation and 3 months follow-up. Conclusion: compared with PLIF, unilateral TLIF has less bleeding and shorter operation time, so it is a kind of lateral treatment.Far-lateral lumbar disc herniation is safer and more reliable.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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