本文選題：腰椎間盤突出癥 + K-rod系統(tǒng)��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究設(shè)計(jì):回顧性隊(duì)列研究目的:對比分析腰椎后路開窗減壓髓核摘除K-rod非融合內(nèi)固定術(shù)與顯微內(nèi)窺鏡下腰椎間盤切除術(shù)(Microendoscopic Discectomy,MED)治療L4/5單一節(jié)段腰椎間盤突出癥的臨床療效。方法:回顧分析2010年12月~2013年07月收治的L4/5單節(jié)段腰椎間盤突出癥患者34例,其中采用K-rod動態(tài)穩(wěn)定系統(tǒng)18例(K-rod組),顯微內(nèi)窺鏡腰椎間盤切除術(shù)16例(MED組),采用功能障礙指數(shù)(Oswestry disability index,ODI)、視覺模擬評分(Visual analogue scale,VAS)及日本骨科協(xié)會評估治療分?jǐn)?shù)(Japanese Orthopedic Association,JOA)作為患者疼痛及功能的評價指標(biāo);影像學(xué)通過PACS系統(tǒng)測量腰椎側(cè)位X線中手術(shù)節(jié)段及上、下鄰近節(jié)段椎間隙變化值,間接評價其退變狀況,通過3.0T MRI對手術(shù)節(jié)段及鄰近節(jié)段椎間盤進(jìn)行Pfirrmann分級,直接評價其退變狀況。平均隨訪時間31個月(18~46個月)。結(jié)果:末次隨訪時,兩組患者的疼痛及功能指標(biāo)(ODI、VAS及JOA評分)均較術(shù)前有顯著改善(P0.05),兩組間無顯著差異(P0.05)。手術(shù)節(jié)段及上位鄰近節(jié)段椎間隙高度K-rod組較術(shù)前增高,MED組較術(shù)前降低,兩組間有顯著差異(P0.05),下位鄰近節(jié)段椎間隙高度組間無顯著性差異(P0.05)。兩組患者Pfirrmann分級的變化顯示,術(shù)后末次隨訪時K-rod組和MED組鄰近節(jié)段椎間盤均發(fā)生不同程度的退變,兩組間手術(shù)節(jié)段及上位鄰近節(jié)段Pfirrmann分級有顯著差異(P0.05),下位鄰近節(jié)段Pfirrmann分級組間無顯著差異(P0.05)。結(jié)論:腰椎后路開窗減壓髓核摘除K-rod非融合內(nèi)固定術(shù)或顯微內(nèi)窺鏡腰椎間盤切除術(shù)(MED)治療單節(jié)段腰椎間盤突出癥均可取得滿意臨床療效,前者在預(yù)防手術(shù)節(jié)段及鄰近節(jié)段退變等方面更有優(yōu)勢。
[Abstract]:Study Design: retrospective cohort study objective: to compare and analyze the clinical effects of posterior decompression and decompression of nucleus pulposus with K-rod nonfusion internal fixation and microendoscopic discectomy with microendoscopic discectomy MED in the treatment of L4 / 5 single segment lumbar disc herniation (L4 / 5). Methods: Thirty-four patients with L4 / 5 single segment lumbar disc herniation from December 2010 to July 2013 were retrospectively analyzed. Among them, 18 cases were treated with K-rod dynamic stabilization system, 16 cases with microendoscopic lumbar discectomy, and 16 cases with meds. The patients were treated with Oswestry disability index, visual analogue score (visual analogue scale) and Japanese Orthopedic association (JOAA). To evaluate the pain and function of patients. PACS system was used to measure the changes of the intervertebral space between the upper and lower adjacent segments of the lumbar vertebrae, and to evaluate the degeneration status indirectly. The operative and adjacent intervertebral discs were graded with Pfirrmann by 3.0T MRI. The degenerative condition is evaluated directly. The mean follow-up time was 31 months (18 ~ 46 months). Results: at the last follow-up, the pain and function indexes of the two groups were significantly improved as compared with those before operation (P 0.05), and there was no significant difference between the two groups (P 0.05). The height of intervertebral space in K-rod group was significantly lower than that in preoperative group. There was a significant difference between the two groups (P 0.05), but there was no significant difference between the two groups (P 0.05). The changes of Pfirrmann grade in both groups showed that the adjacent intervertebral disc degeneration occurred in K-rod group and MED group at the last follow-up. There was significant difference between the two groups in the Pfirrmann grading of the operative segment and the superior adjacent segment, but there was no significant difference between the lower adjacent segment Pfirrmann grading group and the inferior adjacent segment Pfirrmann classification group. Conclusion: the treatment of single segment lumbar disc herniation by posterior fenestration and decompression of nucleus pulposus with K-rod or microendoscopic discectomy is satisfactory. The former has more advantages in preventing the degeneration of surgical segment and adjacent segment.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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