本文選題：植骨融合 + 椎間隙高度　； 參考：《南華大學(xué)》2015年碩士論文

【摘要】：目的本研究通過對(duì)下腰椎退行性疾病后路手術(shù)中四種不同的植骨融合方式進(jìn)行對(duì)比,探討四種不同植骨融合方式的術(shù)后療效,為臨床下腰椎退行性疾病后路手術(shù)選擇可靠的植骨融合方式提供參考。方法收集2010年1月至2014年1月南華大學(xué)附屬郴州市第一人民醫(yī)院脊柱外科實(shí)施了腰椎后路植骨融合術(shù)的478例下腰椎退行性疾病患者的臨床資料。根據(jù)植骨融合方式不同分為四組,行橫突間植骨融合方式的為A組,行椎板關(guān)節(jié)突間植骨融合方式的為B組,行椎體間單純植骨融合方式的為C組和行椎體間融合器融合方式的為D組。對(duì)其中資料完整的下腰椎退行性疾病患者80例(每組選擇20例)為研究對(duì)象進(jìn)行回顧性分析,所有患者均使用了椎弓根螺釘系統(tǒng)內(nèi)固定。統(tǒng)計(jì)并比較四組患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、術(shù)后住院天數(shù)、ODI評(píng)分、VAS評(píng)分、椎間隙高度及植骨融合率。結(jié)果(1)患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量及術(shù)后住院天數(shù)各組間比較差異均無統(tǒng)計(jì)學(xué)差異(p0.05)。(2)各組患者術(shù)前、術(shù)后ODI評(píng)分的臨床治療效果比較及組內(nèi)術(shù)前術(shù)后治療效果比較,四組術(shù)前1天的ODI評(píng)分差異無統(tǒng)計(jì)學(xué)差異(p0.05);四組術(shù)后12月的ODI評(píng)分差異無統(tǒng)計(jì)學(xué)差異(p0.05)。各組內(nèi)術(shù)前1天和術(shù)后12月ODI評(píng)分比較,差異有顯著的統(tǒng)計(jì)學(xué)有意義(p0.001)。(3)四組術(shù)前1天的VAS評(píng)分差異無統(tǒng)計(jì)學(xué)差異(p0.05);四組術(shù)后12月的VAS評(píng)分差異無統(tǒng)計(jì)學(xué)差異(p0.05);各組內(nèi)術(shù)前1天和術(shù)后12月VAS評(píng)分比較,差異有顯著的統(tǒng)計(jì)學(xué)意義(p0.001)。(4)四組術(shù)后3天測(cè)量X線片椎間隙高度均無明顯變化,差異無統(tǒng)計(jì)學(xué)意義(p0.05);術(shù)后6個(gè)月隨訪時(shí)測(cè)量各組X線片椎間隙高度,各組椎間隙高度均有丟失,其中A、B組丟失明顯,與C、D組比較差異有統(tǒng)計(jì)學(xué)差異(p0.05)。術(shù)后12個(gè)月隨訪時(shí)測(cè)量各組X線片椎間隙高度,各組椎間隙高度均有丟失,其中A、B、C組丟失明顯,D組變化不大,A、B、C三組分別與D組比較差異有統(tǒng)計(jì)學(xué)差異(p0.05),D組在12個(gè)月時(shí)明顯優(yōu)于其他3組。(5)四組患者手術(shù)后均于術(shù)后6個(gè)月及12個(gè)月進(jìn)行隨訪,6個(gè)月隨訪時(shí)融合率D組高于A組和B組(p0.05);12月隨訪時(shí)D組融合率高于A組和B組(p0.05),C組融合率高于A組(p0.05)。6個(gè)月及12個(gè)月隨訪時(shí)D組融合率最高。結(jié)論本研究結(jié)果提示:(1)下腰椎退行性疾病后路手術(shù)中橫突間植骨融合方式和椎板關(guān)節(jié)突間植骨融合方式在術(shù)后維持椎間隙高度、植骨融合率上不如椎體間單純植骨融合方式和椎體間融合器融合方式。(2)椎體間融合器融合方式是一種支撐性的融合方式,植骨融合率高,是下腰椎退行性疾病后路手術(shù)中一種較為理想的植骨融合方式。
[Abstract]:Objective to compare the four different bone graft fusion methods in the posterior approach of lumbar degenerative diseases, and to explore the effect of four different bone graft fusion methods. To provide a reference for the selection of reliable bone graft fusion method in posterior surgery of lumbar degenerative diseases. Methods from January 2010 to January 2014, 478 patients with degenerative diseases of lower lumbar vertebrae who underwent posterior lumbar fusion in the Department of Spinal surgery, Chenzhou first people's Hospital, affiliated to South China University, were collected. According to the different ways of bone graft fusion, they were divided into four groups: group A with intertransverse process and group B with interlaminar fusion. Group C and D were performed interbody fusion and interbody fusion respectively. 80 cases of degenerative diseases of lower lumbar vertebrae (20 cases in each group) were retrospectively analyzed. All patients were treated with pedicle screw system fixation. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative hospitalization days, ODI score and VAS score, intervertebral space height and bone graft fusion rate were statistically analyzed and compared among the four groups. Results (1) there was no significant difference in the time of operation, the amount of blood loss during operation, the drainage of blood flow after operation and the days of hospitalization after operation among the groups. There was no significant difference in ODI score between the four groups one day before operation and the ODI score at 12 months after operation in the four groups, and there was no significant difference in the ODI score between the four groups at 12 months after operation (p0.05). ODI scores were compared 1 day before operation and 12 months after operation in each group. There was no significant difference in VAS scores between the four groups on the first day before operation (p 0.05), and there was no significant difference in the VAS scores between the four groups in 12 months after operation (p 0.05). The VAS scores in the first day before operation and in 12 months after operation were compared among the four groups. There was no significant change in the height of intervertebral space in X-ray film 3 days after operation, and there was no significant difference in the height of intervertebral space between the four groups, and the height of intervertebral space in each group was lost after 6 months of follow-up, and the height of intervertebral space in each group was lost at 6 months after the operation, and there was no significant difference in the height of intervertebral space between the four groups at 6 months after operation. There was significant loss in group A (P 0.05), compared with group D (P < 0.05). After 12 months follow-up, the height of intervertebral space was measured in each group, and the height of intervertebral space was lost in each group. There was no significant difference between the three groups and D group. There was significant difference between group D and group D at 12 months. (P < 0.05) all the four groups were followed up 6 and 12 months after operation. The fusion rate of group D was higher than that of group A and group B at 6 months follow-up, and the fusion rate of group D was higher than that of group A and group B at 12 months. The fusion rate of group D was higher than that of group A at 6 months and 12 months. Conclusion the results of this study suggest that the intertransverse bone graft fusion and the laminar articular process fusion in the posterior approach of lower lumbar degenerative diseases maintain the height of the intervertebral space after operation. The fusion rate of bone graft is lower than that of simple fusion between vertebrae and fusion of interbody fusion cage. The fusion rate of interbody fusion cage is a kind of supporting fusion mode, and the fusion rate of bone graft fusion is high. It is an ideal method of bone graft fusion in posterior approach for lumbar degenerative diseases.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 胡萬坤;賀石生;李明;;極外側(cè)入路腰椎椎間融合術(shù)[J];中國(guó)脊柱脊髓雜志;2009年08期

，

本文編號(hào)：1913677