本文選題：坐骨神經(jīng)性脊柱側(cè)凸 + 軀干偏斜�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:一些腰椎間盤突出的患者不僅存在腰部或腿部的疼痛,同時還存在腰部向側(cè)方的偏斜。對于這些患者,他們不僅關(guān)注疼痛的緩解,更關(guān)心側(cè)凸的情況什么時候可以糾正。當(dāng)疼痛通過保守治療不能得到緩解時,手術(shù)治療具有良好的治療效果,側(cè)凸會得到有效的糾正。經(jīng)皮脊柱內(nèi)鏡是一種有效摘除突出髓核的手術(shù)方法,但是文獻(xiàn)中卻鮮有報(bào)道治療脊柱側(cè)凸的治療效果。目的:探討腰椎間盤突出與姿勢性脊柱側(cè)凸間的關(guān)系,總結(jié)經(jīng)皮脊柱內(nèi)鏡治療存在腰椎間盤突出性脊柱側(cè)凸患者的治療效果及意義。方法:采用回顧性研究的方法,選取自2016年1月至2016年8月,中國人民解放軍總醫(yī)院單個醫(yī)生收治的腰椎間盤突出性脊柱側(cè)凸患者47名,其中33名男性,14例女性,年齡在11-57歲之間,平均33.38歲。所有患者均存在嚴(yán)重的腿部疼痛及脊柱側(cè)凸癥狀,神經(jīng)支配區(qū)域麻木患者29例,9例伴有肌力下降,所有患者經(jīng)過1個月以上保守治療無效或存在劇烈急性期疼痛,且未接受過手術(shù)治療。47名患者均接受脊柱內(nèi)鏡腰椎間盤突出髓核摘除術(shù)治療。觀察患者在術(shù)前、術(shù)后3個月、6個月及終末隨訪時視覺模擬評分(Visual Analogue Scale,VAS)評價腰部及腿部疼痛程度。于術(shù)前及末次隨訪時通過Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)及日本骨科協(xié)會評估治療分?jǐn)?shù)(Japanese Orthopaedic Association Scores,JOA)評估患者腰痛功能障礙的情況。通過測量術(shù)前及末次隨訪腰椎Cobb角評價患者側(cè)凸改善情況。結(jié)果:本組47名患者均得到隨訪,隨訪時間為6-14個月,平均11個月。其中1名患者因術(shù)后下肢肌力減弱不緩解,行開放手術(shù);2名患者出現(xiàn)其他節(jié)段再次突出,未行手術(shù)治療。其余44名患者腰椎間盤突出臨床癥狀均明顯改善。腰痛VAS從術(shù)前(5.91±1.36)分別降至術(shù)后3個月(3.93±0.84),術(shù)后6個月(2.72±1.14),末次隨訪(2.11±1.31),組間具有統(tǒng)計(jì)學(xué)差異(F=95.04,P0.001)。腿痛VAS從術(shù)前(7.70±0.98)分別降至術(shù)后3個月(2.23±1.22),術(shù)后6個月(1.81±1.33),末次隨訪(1.38±1.47)。組間具有統(tǒng)計(jì)學(xué)差異(F=260.19,P0.001)。ODI從術(shù)前(68.51±11.75)下降至末次隨訪(11.82±10.12)(Z=-6.71,P0.001);JOA從術(shù)前(8.72±1.64)改善至至末次隨訪(24.47±3.01)(t=-37.22,P0.001),術(shù)后臨床改善率為(77.87±14.10)%。術(shù)前腰椎Cobb角平均為(12.98±5.92)°,術(shù)后末次隨訪腰椎Cobb角平均為(3.81±3.22)°(Z=-5.72,P0.001)。其中10名患者完全糾正,23名患者明顯改善;13名患者改善,1名患者無明顯變化。按照Macnab評分標(biāo)準(zhǔn):優(yōu)30例,良11例,可6例,差1例,總體優(yōu)良率為87.2%。結(jié)論:脊柱內(nèi)鏡技術(shù)具有創(chuàng)傷小、出血少、恢復(fù)快等臨床特點(diǎn)可以通過較小的手術(shù)切口解除患者的臨床癥狀,其中70.2%的患者的脊柱側(cè)凸癥狀得到糾正,對于腰椎間盤突出性脊柱側(cè)凸患者具有較好的治療效果。脊柱側(cè)凸的方向與腰椎間盤突出的位置及有癥狀側(cè)的方向是存在著一定的關(guān)聯(lián)性,即74.4%的脊柱側(cè)凸患者會偏向健側(cè),而70.2%的突出物位于側(cè)凸凸側(cè)的方向。
[Abstract]:Background: some patients with protrusion of the lumbar intervertebral disc not only have pain in the waist or leg, but also the skewness to the side of the waist. For these patients, they not only pay attention to the pain relief, but also care about when the situation of scoliosis can be corrected. When the pain is not relieved through conservative treatment, the surgical treatment has good treatment. The treatment effect, scoliosis will be effectively corrected. Percutaneous endoscopic spinal endoscopy is an effective method to remove the nucleus of the protruding pulp, but there are few reports on the treatment of scoliosis in the literature. Objective: To explore the relationship between protrusion of the lumbar intervertebral disc and postural scoliosis, and to sum up the protrusion of the lumbar intervertebral disc by percutaneous endoscopic Spina endoscopic treatment. Treatment effect and significance of scoliosis patients. Methods: a retrospective study was used to select 47 patients with lumbar disc herniation from January 2016 to August 2016, including 33 men and 14 women with an average age of 11-57 years, with an average of 33.38 years of age. All patients were saved. In severe leg pain and scoliosis symptoms, 29 patients were numbness in the innervation area, 9 were accompanied by a decrease of muscle strength. All patients were ineffective or had acute acute stage pain after 1 months of conservative treatment, and no surgical treatment of.47 patients received endoscopic lumbar disc herniation for treatment. Preoperative, 3 months, 6 months, and final follow-up (Visual Analogue Scale, VAS) were used to evaluate the degree of pain in the waist and leg. The Oswestry dysfunction index (Oswestry disability index, ODI) and the Department of orthopedics Association of Japan were used to evaluate the treatment score (Japanese Orthopaedic Association) before and after the follow-up. OA) evaluation of patients with low back pain dysfunction. Results: 47 patients in this group were followed up with an average of 6-14 months, an average of 11 months, and 1 of them were open to lower limb muscle strength after operation, and 2 patients appeared other segments. The clinical symptoms of lumbar disc herniation in the rest of the 44 patients were obviously improved. Low back pain VAS was decreased from preoperative (5.91 + 1.36) to 3 months (3.93 + 0.84), 6 months (2.72 + 1.14) after operation, and last follow-up (2.11 + 1.31). The group had statistical difference (F=95.04, P0.001). The VAS of leg pain decreased from before operation (7.70 + 0.98). 3 months after operation (2.23 + 1.22), 6 months (1.81 + 1.33) and last follow-up (1.38 + 1.47). There were statistical differences (F=260.19, P0.001).ODI from preoperative (68.51 + 11.75) to last follow-up (11.82 + 10.12) (Z=-6.71, P0.001), JOA from preoperative (8.72 +) to final follow-up (t=-37.22, P0.001), and postoperative clinical changes The good rate was (77.87 + 14.10)% (77.87 + 14.10). The average lumbar Cobb angle was (12.98 + 5.92) degrees (3.81 + 3.22) degrees (3.81 + 3.22) degrees after the last follow-up. 10 patients were completely corrected, 23 patients improved obviously; 13 patients improved and 1 patients were changed. According to the Macnab score standard: 30, 11, 6, 1, and so on. The overall good rate is 87.2%. conclusion: spinal endoscopy has small trauma, less bleeding and rapid recovery. The clinical features can be relieved by a smaller operative incision, of which 70.2% of the patients have a correction of scoliosis and a better therapeutic effect for the patients with protrusion of the lumbar intervertebral disc scoliosis. There is a certain correlation between the direction of the lumbar intervertebral disc herniation and the direction of the symptomatic side, that is, 74.4% of scoliosis patients tend to the healthy side, and 70.2% of the protruding is located in the direction of the scoliosis side.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張琳;張西峰;侯克東;楊華東;蔣續(xù)鋼;李凝道;;改良YESS技術(shù)在治療腰椎間盤突出癥中應(yīng)用的中期臨床療效觀察[J];中華解剖與臨床雜志;2015年06期

2 戴國鋼;劉劍偉;蔚浩;黃雷;王豐;王一;周睿;;椎間盤源性脊柱側(cè)凸的診治分析[J];四川醫(yī)學(xué);2014年11期

3 溫冰濤;張西峰;王巖;肖嵩華;劉鄭生;劉保衛(wèi);張永剛;宋將;種衍學(xué);孫建華;;經(jīng)皮內(nèi)窺鏡治療腰椎間盤突出癥的并發(fā)癥及其處理[J];中華外科雜志;2011年12期

4 張西峰;王巖;肖嵩華;劉鄭生;劉保衛(wèi);張永剛;朱守榮;陸寧;毛克亞;王征;張雪松;;內(nèi)窺鏡下不同入路治療L_5S_1椎間盤突出癥[J];中華骨科雜志;2010年04期

5 趙志明;張永剛;王巖;肖嵩華;劉鄭生;劉保衛(wèi);李海燕;;腰椎后路椎體間融合術(shù)后5年臨床療效觀察[J];中國矯形外科雜志;2010年05期

6 柯?lián)P;劉汝落;;青少年脊柱側(cè)彎流行病學(xué)研究進(jìn)展[J];中國矯形外科雜志;2009年13期

7 王建;周躍;初同偉;王衛(wèi)東;張正豐;李長青;張年春;鄭文杰;潘勇;;內(nèi)窺鏡下單側(cè)神經(jīng)減壓椎間融合椎弓根螺釘固定的臨床應(yīng)用[J];中國矯形外科雜志;2008年19期

8 朱澤章;邱勇;王斌;俞楊;錢邦平;朱鋒;馬薇薇;孫旭;;以脊柱側(cè)凸為首發(fā)癥狀的青少年不典型腰椎間盤突出癥診治分析[J];中華外科雜志;2008年14期

9 張西峰;;側(cè)方入路椎間盤鏡治療腰椎間盤突出癥[J];實(shí)用醫(yī)學(xué)雜志;2007年22期

10 張西峰;王巖;肖嵩華;劉鄭生;劉保衛(wèi);張永剛;;經(jīng)皮側(cè)方入路內(nèi)窺鏡下椎間盤切除術(shù)的可行性及臨床應(yīng)用[J];中國脊柱脊髓雜志;2006年09期

，

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