本文選題：腰椎滑脫 + 康復　； 參考：《福建中醫(yī)藥大學》2015年碩士論文

【摘要】：目的：通過對比不同時間點下床活動對下腰椎滑脫融合內(nèi)固定術后療效的影響,為下腰椎滑脫融合內(nèi)固定術后是否可以早期下床活動提供理論依據(jù)。方法：選取2013年8月至2014年4月在我院住院的75例腰椎滑脫行后路椎間融合內(nèi)固定術的患者,其中男的39例,女的36例,平均年齡為42.4±5.3歲,均診斷為腰椎滑脫癥,其中峽部裂型46例,退行性型29例。按照就診順序編為1-75號,采用區(qū)組隨機化方法,按就診先后順序分配,將患者分為A組,B組,C組各25人。A組：術后第3天下床活動,B組：術后3周下床活動,C組：術后6周下床活動。評價指標包括術前及術后不同時間段的VAS及ODI評分,術后椎間融合率、椎弓根釘松動及斷釘率,術后短期相關并發(fā)癥(包括：腹脹、便秘、壓瘡、肺部感染,泌尿系感染,下肢靜脈血栓)的發(fā)生率。結果：經(jīng)方差分析和LSD法進行兩兩比較后,三組間術前VAS、ODI評分比較差異無統(tǒng)計學意義(均P0.05)。術后各時間段VAS、ODI評分比較差異均有統(tǒng)計學意義(均P0.05)。三組間術后VAS、ODI評分兩兩比較,差異均有統(tǒng)計學意義(均P0.05),且A組分值降低最明顯；三組術后VAS、ODI評分與術前比較均明顯降低,差異有統(tǒng)計學意義(均P0.05)；三組間術后腰椎功能改善率兩兩比較差異均有統(tǒng)計學意義(均P0.05),以A組腰椎功能改善最佳根據(jù)改良Brantigan評分標準,術后6個月A組椎間融合率為58.33%(14/24),B組為52.17%(12/23),C組為54.17%(13/24)。三組融合率比較差異無統(tǒng)計學意義(χ2=0.189,P0.05)；末次隨訪時,A組椎間融合率為79.16%(19/24),B組為73.91%(17/23),C組為70.83%(17/24)。兩組融合率比較差異亦無統(tǒng)計學意義(χ2=0.450,P0.05)。本研究末次隨訪共有18例患者椎間未融合,其中14例患者存在輕度腰部疼痛,4例存在中度腰部疼痛,予口服非甾體類抗炎藥止痛,疼痛明顯緩解。術后隨訪示三組患者未發(fā)現(xiàn)椎弓根釘松動、斷釘。三組患者術后短期并發(fā)癥的比較有統(tǒng)計學意義,其中以A組發(fā)生率最低(P0.05)。結論：腰椎滑脫行后路減壓復位融合內(nèi)固定術后第3天在腰圍保護及陪護的攙扶下下床活動可有效的減少術后疼痛,改善腰椎功能,降低術后短期并發(fā)癥發(fā)生率。
[Abstract]:Objective: to compare the effect of different time points on the effect of lower lumbar spondylolisthesis fusion fixation, and to provide a theoretical basis for early decompression of lower lumbar spondylolisthesis fusion fixation. Methods: from August 2013 to April 2014, 75 patients with lumbar spondylolisthesis underwent posterior interbody fusion and internal fixation, including 39 males and 36 females, with an average age of 42.4 鹵5.3 years, all of whom were diagnosed as lumbar spondylolisthesis. There were 46 cases of isthmic fissure type and 29 cases of degenerative type. According to the order of seeing a doctor, it was numbered 1-75. By using the method of block randomization, the group was assigned according to the order of seeing a doctor. The patients were divided into group A (n = 25) and group C (n = 25). Group A: get out of bed on the 3rd day after operation, group B: group C: 3 weeks after operation: group C: get out of bed 6 weeks after operation. The evaluation indexes included VAS and ODI scores before and after operation, intervertebral fusion rate, pedicle screw loosening and broken nail rate, postoperative short-term complications (including abdominal distension, constipation, pressure sore, pulmonary infection, urinary tract infection), postoperative complications (including abdominal distension, constipation, pressure sore, pulmonary infection, urinary tract infection). The incidence of venous thrombosis in the lower extremity. Results: there was no significant difference in preoperative VAS-ODI scores between the three groups by ANOVA and LSD (all P 0.05). There were significant differences in VASG ODI scores in all postoperative periods (all P 0.05). There were significant differences between the three groups in VAS-ODI score (P0.05%, group A, P < 0.05), the scores of VAS-ODI in group A were significantly lower than those before operation, and the scores were significantly lower in group A than in group A (P < 0.05), and the scores were significantly lower in group A than in group A (P < 0.05). The difference was statistically significant (all P 0.05), and the improvement rate of lumbar vertebrae function was significantly different among the three groups (all P 0.05). The best improvement of lumbar function in group A was based on the improved Brantigan score. 6 months after operation, the intervertebral fusion rate of group A was 58.33% and that of group B was 52.17%, and that of group C was 54.17%, and that of group C was 54.17%. There was no significant difference in the fusion rate among the three groups (蠂 ~ 2 / 0.189 / P 0.05), and the intervertebral fusion rate of group A was 79.16 / 19 / 24 and that of group B was 73.91 / 17 / 23 and that of group C was 70.83 / 24 / 24 at the last follow-up. There was no significant difference in fusion rate between the two groups (蠂 2 0. 450 P 0 05). In the last follow-up, 18 patients were not intervertebral fusion, 14 of them had mild lumbar pain, 4 had moderate waist pain, and were treated with oral NSAIDs to relieve the pain. The follow-up showed that the pedicle nail was not loosened or broken in the three groups. There was significant difference in the short-term postoperative complications among the three groups, among which group A had the lowest incidence (P 0.05). Conclusion: lumbar spondylolisthesis with posterior decompression, reduction, fusion and internal fixation can effectively reduce postoperative pain, improve lumbar function and reduce the incidence of postoperative short-term complications.
【學位授予單位】：福建中醫(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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