發(fā)布時間：2018-04-21 17:38

  本文選題：腰椎退變 + 高位腰椎間盤突出　； 參考：《蘇州大學》2015年碩士論文

【摘要】：第一部分高位腰椎間盤突出癥的手術(shù)治療目的:探討高位腰椎間盤突出癥的臨床特點及手術(shù)治療。方法:回顧性分析2009~2013年收治的36例單節(jié)段高位腰椎間盤突出癥患者的隨訪資料,應(yīng)用改良Macnab標準評價臨床療效,采用視覺模擬疼痛評分(VAS)和Oswestry功能障礙指數(shù)(ODI)評分標準進行量化及統(tǒng)計學分析,SUK標準評估X線植骨融合,CT植骨融合率按照Annette Kettler報導(dǎo)的方法計算,采用獨立樣本t檢驗進行統(tǒng)計學分析。結(jié)果:男24例,女12例,年齡37~66歲,平均55.4歲,隨訪11~43個月,平均24個月。11例L1/2、14例L2/3行TLIF術(shù),11例L2/3行PLIF術(shù)。按改良Macnab評價臨床療效:優(yōu)22例,良8例,可4例,差2例。末次隨訪平均ODI及VAS評分分別為20.62±4.72、2.02±0.74分,均優(yōu)于術(shù)前評分51.22±4.61、8.33±0.82分,差異具有統(tǒng)計學意義(P0.0001)。PLIF術(shù)治療患者術(shù)后VAS及ODI評分較TLIF術(shù)患者差,但無統(tǒng)計學意義。PLIF術(shù)患者術(shù)后6例腦脊液漏,2例持續(xù)神經(jīng)根刺激癥狀,1例大小便功能障礙,Tl IF術(shù)患者無并發(fā)癥發(fā)生。術(shù)后末次隨訪X線及CT評估椎間植骨融合率為100%,術(shù)后腰椎前凸角及椎間隙高度較術(shù)前均有明顯改善。結(jié)論:高位腰椎間盤突出癥的臨床表現(xiàn)復(fù)雜,神經(jīng)損害較重,漏診率高,一旦確診,應(yīng)早期手術(shù)解除壓迫。高位腰椎間盤突出癥PLIF術(shù)并發(fā)癥較多,不宜應(yīng)用,推薦使用TLIF術(shù)。第二部分不同節(jié)段高位腰椎間盤突出的對比研究—ODI評分在腰椎疾患治療中的意義目的:對比分析ODI評分與Prolo評分在高位腰椎間盤突出患者評估中的應(yīng)用,探討高位腰椎的范圍及ODI評分在腰椎間盤突出患者治療中的意義。方法:2008-2013年于我院手術(shù)治療的腰椎間盤突出患者中,隨機選取24例L1-L2及L2-L3節(jié)段突出患者作為A組,24例L3-L4節(jié)段突出患者作為B組,記錄患者術(shù)前及術(shù)后一年的Prolo、ODI評分并對比,以O(shè)DI的改善(降低百分比)評價神經(jīng)功能的恢復(fù),并進行統(tǒng)計學分析。結(jié)果:A、B兩組Prolo評分結(jié)果有明顯差異。兩組患者的術(shù)后ODI較術(shù)前有顯著改善(P0.05)。兩組患者之間術(shù)后ODI評分及ODI的改善差異明顯,有統(tǒng)計學差異(P0.05)。術(shù)前較高的ODI評分對手術(shù)療效的影響是負面的,A組患者中,2位(8.3%)患者術(shù)后評分升高,而B組患者術(shù)后ODI評分均有顯著降低。結(jié)論:L1-L2及L2-L3節(jié)段與L3-L4節(jié)段手術(shù)療效差異明顯。ODI評分較Prolo評分更關(guān)注患者主觀癥狀及功能的改變,對手術(shù)療效有更高的敏感性,建議作為高位節(jié)段突出患者的術(shù)前評估方法。
[Abstract]:Part I: surgical treatment of high lumbar disc herniation objective: to explore the clinical features and surgical treatment of high lumbar disc herniation. Methods: the follow-up data of 36 patients with single segment high lumbar disc herniation from 2009 to 2013 were analyzed retrospectively. The clinical efficacy was evaluated by modified Macnab criteria. The visual analogue pain score (VASA) and the Oswestry dysfunction index (Oswestry) were used for quantitative and statistical analysis. The fusion rate of X-ray bone graft fusion and CT bone graft fusion was calculated according to the method reported by Annette Kettler. Independent sample t test was used for statistical analysis. Results: 24 males and 12 females, aged 3766 years (mean 55.4 years), were followed up for 11 ~ 43 months, with an average of 24 months. 14 cases of L 2 / 3 with L 2 / 3 were treated with TLIF. 11 cases with L 2 / 3 were treated with PLIF. The clinical efficacy was evaluated by modified Macnab: excellent in 22 cases, good in 8 cases, fair in 4 cases, poor in 2 cases. The mean ODI and VAS scores of the last follow-up were 20.62 鹵4.72 鹵2.02 鹵0.74, respectively, which were better than those of the preoperative scores of 51.22 鹵4.61 and 8.33 鹵0.82, respectively. The difference was statistically significant (P 0.0001U, P 0.0001A, P < 0.05). The VAS and ODI scores of the patients treated with TLIF were lower than those of the patients with TLIF. However, there was no statistical significance in 6 cases of cerebrospinal fluid leakage and 2 cases of persistent nerve root irritation after PLIF. There was no complication in 1 case of dysphoria and urinal dysfunction. The rate of intervertebral bone graft fusion was 100 in the last follow-up. The lumbar kyphosis angle and the height of intervertebral space were significantly improved after operation. Conclusion: the clinical manifestation of high lumbar disc herniation is complicated, the nerve damage is serious, and the rate of missed diagnosis is high. High lumbar intervertebral disc herniation (PLIF) has many complications and should not be used. TLIF is recommended. The significance of ODI score and Prolo score in the treatment of Lumbar Disc Disc Herniation objective: to compare and analyze the application of ODI score and Prolo score in the evaluation of patients with high lumbar disc herniation. To explore the range of high lumbar vertebrae and the significance of ODI score in the treatment of lumbar disc herniation. Methods from 2008 to 2013, 24 patients with L1-L2 and L2-L3 segment herniation were randomly selected as group A and 24 patients with L3-L4 segment herniation as group B. Prologil ODI scores before and after operation were recorded and compared. The improvement (decrease percentage) of ODI was used to evaluate the recovery of neural function. Results there was significant difference in Prolo score between the two groups. The postoperative ODI in both groups was significantly improved than that before operation (P 0.05). There was significant difference in ODI score and ODI between the two groups (P 0.05). The effect of high preoperative ODI score on the operative efficacy was that the postoperative scores of 2 patients in group A were significantly higher than those in group B, but the ODI scores in group B were significantly lower than those in group A. Conclusion compared with Prolo score, the score of Prolo is more concerned with the changes of subjective symptoms and functions, and has a higher sensitivity to the operative efficacy. It is suggested to be a preoperative evaluation method for the patients with high segmental protrusion.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

【參考文獻】

相關(guān)期刊論文 前3條

1 曾志遠，吳家和，，陳為義，潘丈譽，黃伯成，施建輝，陳傳昌，吳珊鵬;高位腰椎間盤突出癥臨床特點（附6例報告）[J];頸腰痛雜志;1994年01期

2 張力,侯勇,陳允震,潘新,李牧;胸腰段椎間盤突出癥的手術(shù)治療[J];山東大學學報(醫(yī)學版);2005年02期

3 鄭勇;王建;袁超;鄭文杰;李長青;張正豐;周躍;;微創(chuàng)經(jīng)椎間孔腰椎間融合術(shù)治療高位腰椎間盤突出癥[J];中國修復(fù)重建外科雜志;2014年04期

本文編號：1783425