發(fā)布時間：2018-05-05 05:14

  本文選題：Dynesys + 植骨融合內固定術　； 參考：《成都中醫(yī)藥大學》2015年碩士論文

【摘要】：背景：植骨融合內固定已被認為是治療退變性腰椎不穩(wěn)金標準,但術后鄰近節(jié)段退變問題越來越受關注。在此背景下,非融合技術應用于臨床。目的：回顧性分析和對比Dynesys動態(tài)穩(wěn)定系統(tǒng)和后路植骨融合內固定術治療退變性腰椎不穩(wěn)的患者的近期臨床療效及影像學資料,評價近期臨床療效及末次隨訪鄰近節(jié)段退變。方法：回顧分析我科室2012年12月至2014年5月期間收治經(jīng)手術治療腰椎退變性不穩(wěn)患者28例,采用椎管減壓結合椎弓根動態(tài)穩(wěn)定系統(tǒng)(觀察組,Dynesys, A組,14例)與后路減壓椎間融合術(對照組,PLIF,B組,14例),記錄兩組患者術前、術后1月、3月、6月、12月及末次隨訪疼痛視覺模擬評分(Visual Analogue Scale/Score,簡稱VAS)、0swestry功能障礙指數(shù)評分(0DI評分)并且收集術前及隨訪時腰椎正側位片及動力位片,采用White鄰近節(jié)段退變判斷標準,評價末次隨訪影像學ASD,對所得數(shù)據(jù)進行統(tǒng)計學SPSS17.0分析。結果：所有患者都得到隨訪,平均隨訪18±3.4個月。兩組患者術后1月、3月、6月、12月及末次隨訪VAS評分、ODI評分均較術前明顯改善,均有顯著統(tǒng)計學差異(P0.05)；兩組患者術后各時間段VAS評分、ODI評分對比無統(tǒng)計學差異(P0.05)；末次隨訪觀察組影像學ASD 1例；對照組鄰近節(jié)段影像學退變者4例,觀察組末次隨訪ASD發(fā)病率更低,兩者對比有統(tǒng)計學差異(P0.05)。結論：1、Dynesys動態(tài)穩(wěn)定系統(tǒng)治療退變性腰椎不穩(wěn)相比于傳統(tǒng)植骨融合內固定術近期臨床療效相當；可提供腰椎穩(wěn)定性,改善臨床癥狀；2、Dynesys動態(tài)穩(wěn)定系統(tǒng)能保留運動節(jié)段部分活動度,明顯降低影像學ASD發(fā)病率,臨床上治療腰椎退變性不穩(wěn)可推廣使用。
[Abstract]:Background: bone graft fusion and internal fixation have been regarded as the gold standard for the treatment of degenerative lumbar instability. In this context, non-fusion techniques are applied in clinical practice. Objective: to retrospectively analyze and compare the short-term clinical effect and imaging data of patients with degenerative lumbar spine instability treated by Dynesys dynamic stabilization system and posterior bone graft fusion and internal fixation. Methods: from December 2012 to May 2014, 28 cases of lumbar degenerative instability were treated with surgical treatment. Spinal canal decompression combined with pedicle dynamic stabilization system (observation group, n = 14) and posterior decompression and interbody fusion (control group, n = 14) were used to record the patients before operation. Visual Analogue scale / Score.Visual Analogue scale score of visual analogue score (VAS / 0 swestry dysfunction index) was followed up at 1 month, 3 months, 6 months, 12 months and the last follow-up. The anterior and lateral lumbar vertebrae films and dynamic position films were collected before and after follow-up, and the White adjacent segment degeneration criteria were used. To evaluate the last follow-up imaging ASD, the data were analyzed by SPSS17.0. Results: all patients were followed up for an average of 18 鹵3.4 months. The VAS scores were significantly improved in both groups at 1 month, 3 months, 6 months, 12 months and the last follow-up. There were significant statistical differences between the two groups (P 0.05), there was no significant difference in VAS scores between the two groups at each time after operation (P 0.05), the imaging ASD in the last follow-up group (n = 1) and the control group (n = 4) had degenerative changes in the adjacent segment, and there was no significant difference between the two groups (P < 0.05). The incidence of ASD in the last follow-up group was lower than that in the control group (P 0.05). Conclusion compared with traditional bone graft fusion and internal fixation, the dynamic stabilization system of dystroy of degenerative lumbar vertebrae can provide stability of lumbar vertebrae and improve the clinical symptoms of dyesys dynamic stabilization system, which can preserve the motion degree of degenerative lumbar vertebrae, and it is effective in the treatment of degenerative lumbar vertebrae instability. The incidence of imaging ASD was significantly reduced and the clinical treatment of lumbar degenerative instability could be popularized.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：1846351