本文選題：退變性腰椎滑脫 + 微創(chuàng)TLIF　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的兩種手術(shù)方式治療退行性腰椎失穩(wěn)滑脫的對(duì)比分析。方法回訪收集分析2014年1月1日至2014年12月31日期間新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院骨外科收住院的老年性輕度腰椎滑脫患者56例,分別采用微創(chuàng)TLIF和開放TLIF手術(shù)方式,微創(chuàng)TLIF的手術(shù)方法,即在Quadrant系統(tǒng)引導(dǎo)下,直視進(jìn)行圓錐、神經(jīng)根及椎管減壓,不穩(wěn)定椎體植骨融合,椎弓根螺釘三柱內(nèi)固定。微創(chuàng)TLIF手術(shù)患者26例,開放后路TLIF手術(shù)患者30例。分別按照術(shù)中切口長(zhǎng)度(cm)、手術(shù)時(shí)間(min)、術(shù)中及術(shù)后出血量(ml)、總住院天數(shù)(d)等數(shù)據(jù)來(lái)統(tǒng)計(jì);通過(guò)視覺(jué)模擬評(píng)分的方法和JOA下腰痛評(píng)分系統(tǒng),將手術(shù)前癥狀,分別對(duì)比患者術(shù)后癥狀的改善程度,周期分為三天、兩周、三月、半年、一年,加以統(tǒng)計(jì)分析;觀察患者術(shù)前術(shù)后1周、半年、1年所測(cè)量的椎體滑脫角、滑脫率的糾正情況,椎間隙高度的撐開恢復(fù)情況,術(shù)后隨訪拍攝術(shù)后半年、1年CT及X線片通過(guò)同一副主任醫(yī)師影像學(xué)評(píng)估椎體間固定植骨融合率。結(jié)果微創(chuàng)TLIF組中,26例患者全部獲得術(shù)后半年隨訪,4例患者在術(shù)后1年失訪;而在開放手術(shù)組中,有5例患者失去隨訪,失訪率16%;隨訪時(shí)間跨度為6-30個(gè)月,平均19個(gè)月。對(duì)比分析兩組術(shù)后傷口長(zhǎng)度,總體出血量,住院總天數(shù),微創(chuàng)組較開放組少,統(tǒng)計(jì)學(xué)存在差異,本次研究手術(shù)均由熟練的高年資醫(yī)師操作,手術(shù)耗時(shí)總體相比開放手術(shù)組短,但P0.05,統(tǒng)計(jì)學(xué)差異不明顯。通過(guò)術(shù)后癥狀分析,患者的VAS、JOA評(píng)分、ODI均反映出癥狀減輕,手術(shù)效果良好,統(tǒng)計(jì)學(xué)計(jì)算存在顯著性差異(P0.05)。同樣的,通過(guò)術(shù)后3月癥狀分析,患者的VAS、JOA評(píng)分、ODI均反映出癥狀明顯減輕,手術(shù)效果良好,統(tǒng)計(jì)學(xué)計(jì)算存在顯著性差異(P0.05)。術(shù)后影像學(xué)檢查數(shù)據(jù)顯示兩組腰椎滑脫角、椎間隙高度、滑脫率均較術(shù)前有明顯糾正,術(shù)前術(shù)后存在明顯統(tǒng)計(jì)學(xué)差異,而兩組間對(duì)比無(wú)統(tǒng)計(jì)學(xué)差異。影像學(xué)分析微創(chuàng)手術(shù)組在術(shù)后6月的融合率(Suk標(biāo)準(zhǔn))達(dá)到88.5%,術(shù)后6個(gè)月融合率微創(chuàng)TLIF組23例(88.5%),開放TLIF組14例(46.7%),兩組1年后的融合率微創(chuàng)TLIF組20例(76.9%)(注:術(shù)后1年,微創(chuàng)TLIF組26例患者中失訪4例),5例可能融合;開放TLIF組23例(76.7%)(注:術(shù)后1年,開放TLIF組30例患者中失訪5例),3例可能融合;盡管相比開放組,微創(chuàng)組術(shù)后6個(gè)月顯示出了更高的融合率,但并無(wú)明顯統(tǒng)計(jì)學(xué)差異,P0.05。結(jié)論微創(chuàng)TLIF手術(shù)方式和開放TLIF手術(shù)方式相比較,減少了手術(shù)出血量,住院時(shí)間縮短,術(shù)后恢復(fù)較快,減少了術(shù)后慢性腰痛及腰椎術(shù)后綜合征的發(fā)生,滑脫的糾正,椎間高度的恢復(fù)及融合率與開放術(shù)式區(qū)別不大。因此,對(duì)于老年退變行椎管狹窄及滑脫失穩(wěn),微創(chuàng)TLIF技術(shù)是有效的治療手段。
[Abstract]:Objective to compare the two surgical methods in the treatment of degenerative spondylolisthesis. Methods from January 1, 2014 to December 31, 2014, 56 cases of senile mild lumbar spondylolisthesis in the first affiliated Hospital of Xinxiang Medical College were collected and analyzed. The patients were treated with minimally invasive TLIF and open TLIF respectively. Under the guidance of Quadrant system, minimally invasive TLIF was performed with conical decompression, nerve root and spinal canal decompression, unstable bone graft fusion and pedicle screw fixation. There were 26 cases of minimally invasive TLIF operation and 30 cases of open posterior TLIF operation. According to the length of incision, the time of operation, the amount of blood lost during and after operation, the total days of hospitalization, and so on, the symptoms before operation were evaluated by visual analogue scoring method and low back pain scoring system under JOA. The period was divided into three days, two weeks, three months, six months, one year, to make statistical analysis, to observe the correction of spondylolisthesis angle and rate of spondylolisthesis measured 1 week, half a year and one year before and after operation. The height of intervertebral space was opened and recovered. The fusion rate of interbody fixation was evaluated by CT and X ray radiographs at 1 year after follow up half a year after operation by the same assistant chief physician. Results in the minimally invasive TLIF group, all the 26 patients were followed up half a year after operation and 4 patients lost their visit at 1 year after operation, while in the open operation group, 5 patients lost the follow-up and the lost visit rate was 16. The follow-up time ranged from 6 to 30 months, with an average of 19 months. The length of wound, the amount of blood loss, the total length of hospitalization, the number of patients in the minimally invasive group were less than those in the open group, and there were statistical differences between the two groups. The operation in this study was performed by a skilled senior physician, and the total duration of the operation was shorter than that in the open operation group. But P0.05, the statistical difference is not obvious. Through the analysis of postoperative symptoms, the patients' VAS-JOA score and ODI all reflected the relief of symptoms, and the effect of operation was good. There was significant difference in statistical calculation (P 0.05). Similarly, through the symptom analysis of 3 months after operation, the patients' VASV JOA score and ODI showed that the symptoms were obviously relieved and the operation effect was good. There was a significant difference in statistical calculation between the two groups (P 0.05). The postoperative imaging data showed that the lumbar spondylolisthesis angle, height of intervertebral space and the rate of spondylolisthesis were significantly corrected in the two groups, and there was significant statistical difference between the two groups before and after operation, but there was no statistical difference between the two groups. The fusion rate was 88.5in the minimally invasive operation group (6 months after operation), in the minimally invasive TLIF group (23 cases) at 6 months after operation, in the open TLIF group (14 cases) and in the open TLIF group (46.7%). The fusion rate of the two groups after one year in the minimally invasive TLIF group (20 cases) was 76.9cm (note: 1 year after operation). Of the 26 patients in the minimally invasive TLIF group, 4 had lost access and 5 were likely to be fused, while in the open TLIF group, there were 23 cases with 76. 710% of the 30 patients in the open TLIF group, 5 of the 30 patients in the open TLIF group were likely to be fused, although compared with the open group, 3 cases were likely to be fused. In the minimally invasive group, a higher fusion rate was found 6 months after operation, but there was no significant difference between the two groups (P 0.05). Conclusion compared with open TLIF, minimally invasive TLIF can reduce the amount of bleeding, shorten the hospital stay, recover quickly after operation, reduce the incidence of postoperative chronic low back pain and lumbar spondylolumbar syndrome, and correct spondylolisthesis. The recovery and fusion rate of intervertebral height was not different from that of open operation. Therefore, minimally invasive TLIF is an effective treatment for degenerative spinal canal stenosis and slippage instability.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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