本文選題：單側(cè)椎弓根螺釘內(nèi)固定 + 椎間融合��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：比較單側(cè)和雙側(cè)椎弓根螺釘固定聯(lián)合患側(cè)腰椎板切除椎管擴(kuò)大減壓椎間cage植骨融合術(shù)治療雙節(jié)段腰椎間盤突出癥伴退變性腰椎不穩(wěn)的臨床療效,評(píng)估單側(cè)椎弓根螺釘內(nèi)固定優(yōu)勢(shì)和可行性。方法：回顧性分析自2012年6月-2015年2月我科收治的36例資料完整的雙節(jié)段腰椎間盤突出癥伴退變性腰椎不穩(wěn)患者,其中A組18例采用單側(cè)椎弓根固定,B組18例采用雙側(cè)椎弓根固定,所有病例均行患側(cè)椎板切除,椎管擴(kuò)大減壓,神經(jīng)松解及椎間cage融合術(shù)。記錄A組、B組的手術(shù)時(shí)間、術(shù)中出血、術(shù)后引流量及住院時(shí)間,并根據(jù)JOA(日本骨科協(xié)會(huì))評(píng)分和VAS(視覺(jué)模擬量表)評(píng)分全面評(píng)估研究對(duì)象手術(shù)前后腰部癥狀以及下肢麻痛程度,并根據(jù)所獲得分估算術(shù)后改善率,隨訪期間行腰椎正側(cè)位片,末次隨訪時(shí)均行腰椎平掃+雙能CT,觀察植骨融合情況,計(jì)算椎間植骨融合率,隨訪時(shí)間為7-32個(gè)月,平均為19.5個(gè)月。結(jié)果：研究結(jié)果表明,A組中手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量均少于B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；在住院時(shí)間方面,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；在并發(fā)癥方面,單邊組發(fā)現(xiàn)1例螺帽松動(dòng),余均未發(fā)現(xiàn)螺釘松動(dòng)、斷裂、cage滑脫、移位或下沉,兩組比較無(wú)統(tǒng)計(jì)學(xué)上的差異；在JOA評(píng)分及VAS評(píng)分方面,兩組術(shù)前術(shù)后比較差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：?jiǎn)蝹?cè)、雙側(cè)椎弓根螺釘內(nèi)固定聯(lián)合椎間cage融合治療雙節(jié)段腰椎間盤突出癥伴退變性腰椎不穩(wěn)近期療效肯定,均能使腰椎獲得可靠的穩(wěn)定,臨床癥狀改善明顯,椎間融合率均高,但前者在手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量方面占優(yōu),并且手術(shù)相對(duì)簡(jiǎn)單、術(shù)區(qū)周圍組織損傷相對(duì)小,可減少術(shù)后相關(guān)并發(fā)癥。
[Abstract]:Objective: to compare the clinical effects of unilateral and bilateral pedicle screw fixation combined with laminectomy and extended decompression with cage bone grafting and fusion in the treatment of double segment lumbar disc herniation with degenerative lumbar instability. To evaluate the advantages and feasibility of unilateral pedicle screw fixation. Methods: from June 2012 to February 2015, 36 patients with double-segment lumbar disc herniation with degenerative lumbar vertebrae instability were retrospectively analyzed. 18 cases of group A were treated with unilateral pedicle fixation and 18 cases of group B were treated with bilateral pedicle fixation. All the patients were treated with ipsilateral laminectomy, enlarged decompression of spinal canal, neurolysis and intervertebral cage fusion. The time of operation, intraoperative bleeding, postoperative drainage and hospitalization time were recorded in group A and group B. The waist symptoms and anaesthesia degree of lower limbs were evaluated according to JOA( Japan Orthopaedic Association) score and VAS (Visual Analog scale) score. According to the score obtained, the rate of improvement was estimated. During the follow-up period, the anterior and lateral lumbar films were performed, and at the last follow-up, the dual energy CT scan of the lumbar vertebrae was performed. The fusion of bone graft was observed, and the fusion rate of intervertebral graft was calculated. The follow-up time was 7-32 months, with an average of 19.5 months. Results: the results showed that the time of operation, the amount of intraoperative bleeding and postoperative drainage in group A were less than those in group B, and the difference was statistically significant (P 0.05), but there was no significant difference in the length of hospitalization between the two groups (P 0.05). There was no significant difference in JOA score and VAS score between the two groups in terms of JOA score and VAS score. Conclusion: unilateral and bilateral pedicle screw internal fixation combined with intervertebral cage fusion in the treatment of two-level lumbar disc herniation with degenerative lumbar instability has positive short-term curative effect, which can make the lumbar vertebrae obtain reliable stability, and the clinical symptoms are improved obviously. The rate of intervertebral fusion was high, but the former was superior in operation time, intraoperative blood loss and postoperative drainage, and the operation was relatively simple, and the injury of surrounding tissues was relatively small, which could reduce the postoperative complications.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1871872