發(fā)布時(shí)間：2018-05-25 19:27

  本文選題：腰椎間盤突出癥 + 經(jīng)椎間孔椎體間融合(TLIF)　； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：背景腰椎間盤突出癥是指由于腰椎髓核、纖維環(huán)、軟骨終板以及周圍韌帶等隨著年齡增長(zhǎng)而出現(xiàn)退行性改變,最終導(dǎo)致腰腿痛、下肢放射疼等臨床癥狀及體征為主要臨床表現(xiàn)一類疾病。近年來,腰椎間盤疾病的發(fā)生率在人群中隨著年齡的增長(zhǎng)而逐步增加,其診斷與治療已成為臨床研究的焦點(diǎn)。國內(nèi)外的骨科醫(yī)師在腰椎間盤突出癥的治療中根據(jù)自已對(duì)腰椎間盤突出疾病的理解采用了不同的手術(shù)方法,在腰椎間盤摘除后又有如下融合術(shù)：如后外側(cè)融合(Posterior lateral fusion,PLF),經(jīng)后路椎體間融合(Posterior lumber interbody fusion,PLIF),經(jīng)前路椎體間融合(Anterior lumbar interboby fusion,ALIF),經(jīng)腰椎間孔椎間融合(Transforminal lumbar interboby fusion,TILF)等手術(shù)。但是怎樣提高脊柱的穩(wěn)定性,增加脊柱植骨的融合率,減少患者的創(chuàng)傷、縮短患者的病vR時(shí)間,提高其生活質(zhì)量等一系列問題尚未得到完善的解決,而且各種手術(shù)方式均有優(yōu)缺點(diǎn)。目的本研究收集因腰椎間盤間突出癥而行經(jīng)腰椎間孔椎間融合(TLIF)與后路椎體間融合(PLIF)兩種手術(shù)方式的患者資料。探討這兩種手術(shù)方式對(duì)治療腰椎間盤突出癥的療效優(yōu)缺點(diǎn)。進(jìn)行對(duì)比分析研究,為該種疾病治療方式的選擇提供依據(jù)。方法回顧性分析2012年10月-2014年6月入院治療的腰椎間盤突出癥患者80例臨床資料。獲得完整隨訪者80例,分為TLIF與PILF兩組。每組40例。TLIF組給予TLIF術(shù)治療；PLIF組給予PLIF術(shù)治療。觀察比較兩組手術(shù)時(shí)間、術(shù)中出血量、臥床時(shí)間、椎體間融合率及融合時(shí)間等情況。結(jié)果TLIF組手術(shù)時(shí)間與術(shù)中出血量均少于PLIF組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)TLIF組較PLIF組術(shù)后隨訪時(shí)Oswestry (ODI)障礙指數(shù)、VAS評(píng)分良好,差異有統(tǒng)計(jì)學(xué)意義(P0.05) TLIF組總有效率為90.0%,PLIF組總有效率為87.5%。差異有統(tǒng)計(jì)學(xué)意義(P0.05).所有患者術(shù)后3-6月影像學(xué)檢查均顯示椎間融合良好。其中TLIF組1例患者術(shù)后因發(fā)生車禍導(dǎo)致釘棒斷裂。1例小腿外側(cè)麻木,無切口感染,無腦脊液漏的發(fā)生。PLIF組術(shù)后患者內(nèi)固定無一釘棒松動(dòng)及斷裂。2例小腿外側(cè)麻木,1例患有腦脊液漏。有2例切口感染,使用抗生素以及勤加換藥后患者恢復(fù)良好。結(jié)論兩組椎間融合率高,保持了脊柱的穩(wěn)定性。經(jīng)腰椎間孔椎間融合術(shù)式(TLIF)較經(jīng)后路椎體間融合術(shù)式(PLIF)手術(shù)時(shí)間短、術(shù)中出血量少值得臨床推廣應(yīng)用。
[Abstract]:Background Lumbar disc herniation is a degenerative change of lumbar nucleus pulposus, fibrous ring, endplate of cartilage and surrounding ligament with age, which eventually leads to low back pain. Radiation pain and other clinical symptoms and signs are the main clinical manifestations of a disease. In recent years, the incidence of lumbar disc disease in the population with the increase of age, its diagnosis and treatment has become the focus of clinical research. In the treatment of lumbar disc herniation, orthopaedic physicians at home and abroad have adopted different surgical methods according to their own understanding of lumbar disc herniation. After lumbar discectomy, the following procedures were performed: posterolateral lateral fusion, posterior lumber interbody fusion, anterior lumbar interboby fusion and transforminal lumbar interboby fusion. However, how to improve the stability of the spine, increase the fusion rate of bone graft, reduce the trauma of patients, shorten the time of disease VR, improve their quality of life and a series of problems have not been solved. And all kinds of surgical methods have advantages and disadvantages. Objective to collect the data of patients with lumbar intervertebral disc herniation by transforaminal intervertebral fusion (TLIF) and posterior interbody fusion (PLIF). To explore the advantages and disadvantages of these two surgical methods in the treatment of lumbar disc herniation. A comparative study was carried out to provide a basis for the selection of treatment methods for the disease. Methods the clinical data of 80 patients with lumbar disc herniation from October 2012 to June 2014 were retrospectively analyzed. 80 cases were followed up completely and divided into two groups: TLIF and PILF. Each group of 40 cases. TLIF group was treated with TLIF and PLIF group was treated with PLIF. The operation time, blood loss, bed rest time, fusion rate and fusion time were observed and compared between the two groups. Results the time of operation and the amount of intraoperative bleeding in TLIF group were lower than those in PLIF group. The difference was statistically significant (P 0.05) compared with that in PLIF group (P 0.05). The index of Oswestry dysfunction was better than that in PLIF group. The difference was significant (P 0.05). The total effective rate of TLIF group was 90.0% and the total effective rate was 87.5%. The difference was statistically significant (P 0.05). 3-6 months after operation, all patients showed good intervertebral fusion. In the TLIF group, one patient suffered from a traffic accident after operation, which resulted in the fracture of the rod and the lateral numbness of the leg. There was no incision infection. No cerebrospinal fluid leakage occurred. In PLIF group, there was no loosening of nail and rod and no fracture. 2 cases had lateral leg numbness and 1 case had cerebrospinal fluid leakage. Two cases of incision infection recovered well after antibiotic use and frequent dressing change. Conclusion the rate of intervertebral fusion between the two groups is high and the stability of spine is maintained. The time of transforaminal interbody fusion (TLIF) is shorter than that of posterior interbody fusion (PLIF), and the less intraoperative bleeding is worth popularizing.
【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】：2015
【分類號(hào)】：R687.3

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