本文選題：椎板截骨回植 + 硬膜外纖維化　； 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的 觀察后路腰椎椎間融合(posterior lumbar interbody fusion,PLIF)椎板截骨回植術(shù)與PLIF椎板全切術(shù)治療單節(jié)段腰椎退行性疾病的臨床療效,并對比觀察術(shù)后硬膜外纖維化(epidural fibrosis,EF)和相鄰節(jié)段退變(adjacent segment degeneration,ASD)發(fā)生率的差異,探討應(yīng)用PLIF治療單節(jié)段腰椎退行性疾病的最佳手術(shù)方式。方法 研究選取陜西省人民醫(yī)院脊柱外科2009年1月至2014年1月期間應(yīng)用PLIF椎板截骨回植術(shù)與PLIF椎板全切術(shù)治療的單節(jié)段腰椎退行性疾病并獲得完整隨訪的病例,根據(jù)本研究的納入與排除標(biāo)準(zhǔn)回顧性分析167例病例資料。將全部病例根據(jù)手術(shù)方式的不同分為兩組:椎板回植組(行PLIF椎板截骨回植術(shù),納入82例)和椎板全切組(行PLIF椎板全切術(shù),納入85例),兩組除術(shù)式不同外余治療、護理、隨訪完全一致。對比觀察兩組患者術(shù)前及術(shù)后1周、3月、6月、12月、24月、36月的疼痛視覺模擬評分(Visual analogue scale,VAS)、日本矯形外科學(xué)會(Japanese orthopaedic association,JOA)下腰痛評分、Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)及影像學(xué)資料,分析兩組臨床療效、椎間融合優(yōu)良率及術(shù)后EF和ASD發(fā)生率的差異。所得數(shù)據(jù)均采用SPSS 18.0統(tǒng)計學(xué)軟件處理分析,計量資料組間對比選擇兩獨立樣本t檢驗,組內(nèi)對比選擇配對樣本t檢驗,計數(shù)資料對比選擇χ2檢驗,檢驗水準(zhǔn)設(shè)置為0.05。結(jié)果 末次隨訪時兩組患者VAS評分、JOA評分、ODI指數(shù)分別較術(shù)前顯著改善,其差異均具有良好的統(tǒng)計學(xué)價值(P0.05)。椎板回植組末次隨訪時三項評分分別為(2.0±1.1)分、(24.0±1.8)分、(19.8±8.2)%,椎板全切組分別為(2.5±1.6)分、(23.3±2.0)分、(22.5±8.5)%,兩組相比,三項評分均顯示了良好的統(tǒng)計學(xué)差異性(P0.05)。Macnab優(yōu)良率:椎板回植組為96.34%,椎板全切組為85.88%,兩組相比其差異具有統(tǒng)計學(xué)意義(P0.05)。椎間融合優(yōu)良率:椎板回植組為97.56%,椎板全切組為92.94%。隨訪過程中椎板回植組共出現(xiàn)16例EF,發(fā)生率為19.51%,椎板全切組共出現(xiàn)30例EF,發(fā)生率為35.29%,兩組相比其差異具有統(tǒng)計學(xué)意義(P0.05);椎板回植組共出現(xiàn)20例ASD,發(fā)生率為24.39%,椎板全切組共出現(xiàn)37例ASD,發(fā)生率為43.53%,兩組相比其差異具有統(tǒng)計學(xué)意義(P0.05)。末次隨訪時全部EF(+)ASD(-)患者的三項評分分別為(2.7±1.8)分、(22.0±1.9)分、(24.4±9.0)%,EF(-)ASD(+)患者分別為(2.9±1.5)分、(21.6±2.0)分、(25.7±8.7)%,其二者分別與EF(-)ASD(-)患者的(1.7±1.0)分、(25.6±1.6)分、(16.3±7.1)%相比,差異均顯示出良好的統(tǒng)計學(xué)價值(P0.05)。結(jié)論 本次課題回顧性研究了167例分別應(yīng)用PLIF椎板截骨回植術(shù)與PLIF椎板全切術(shù)治療的單節(jié)段腰椎退行性疾病的病例資料,兩種術(shù)式均取得了理想的臨床治療效果。PLIF椎板截骨回植術(shù)與PLIF椎板全切術(shù)相比,具有更優(yōu)的臨床療效和更低的術(shù)后EF及ASD發(fā)生率。本研究結(jié)果可為脊柱外科臨床實踐中單節(jié)段腰椎退行性疾病手術(shù)方式的選擇提供參考,對指導(dǎo)手術(shù)規(guī)劃、降低術(shù)后并發(fā)癥發(fā)生率有重要的理論價值與臨床意義。
[Abstract]:Objective To observe the clinical efficacy of posterior lumbar interbody fusion (posterior lumbar interbody fusion (PLIF) intervertebral osteotomy and PLIF laminectomy for the treatment of single segment lumbar degenerative disease, and to compare the incidence of postoperative epidural fibrosis (epidural fibrosis, EF) and adjacent segment degeneration (adjacent segment degeneration). The best surgical methods for the treatment of single segment lumbar degenerative disease with PLIF were studied. Methods study selected the cases of single segment lumbar degenerative disease treated by PLIF vertebral osteotomy and PLIF laminectomy during the period of January 2009 to January 2014 of Shaanxi People's Hospital. The inclusion and exclusion criteria of 167 cases were analyzed retrospectively. All cases were divided into two groups according to the different surgical methods: vertebral lamina replanting group (PLIF vertebral lamina osteotomy and replanting, 82 cases) and laminectomy group (PLIF laminectomy, included in 85 cases), the two groups were treated with different external treatment, nursing, and complete follow up. The two groups of patients were observed before and 1 weeks, March, June, December, 24 months, 36 months, Visual analogue scale, VAS, the Japanese Orthopedic Association (Japanese Orthopaedic Association, JOA) lower back pain score, Oswestry dysfunction index (Oswestry disability index,) and imaging data, analysis of two groups of clinical effects, The good rate of interbody fusion and the difference in the incidence of EF and ASD after the operation were analyzed by SPSS 18 statistics software, two independent sample t tests were selected between the groups of measurement data, the comparison selected paired sample t test, the count data contrast selection chi 2 test, and the test level set at the last follow-up of two groups of 0.05. results. The VAS score, the JOA score and the ODI index were significantly better than those before the operation (P0.05). The three scores of the vertebral lamina replanting group were (2 + 1.1), (24 + 1.8), (19.8 + 8.2)%, and (23.3 + 1.6), (23.3 + 2), (22.5 + 8.5)% respectively. The good rate of statistical difference (P0.05).Macnab was good: the vertebral lamina replanting group was 96.34%, the laminectomy group was 85.88%, and the difference between the two groups was statistically significant (P0.05). The good rate of intervertebral fusion was 97.56%, and the laminectomy group was 16 cases of EF in the vertebral lamina replanting group during the course of the 92.94%. visit. The incidence rate was 19.51%, There were 30 cases of EF in the laminectomy group, the incidence rate was 35.29%, and the difference between the two groups was statistically significant (P0.05); the vertebral lamina replanting group had 20 cases of ASD, the incidence was 24.39%, the total vertebral lamina resection group had 37 cases of ASD, the incidence was 43.53%, and the difference between the 35.29% groups was P0.05. At the last follow-up, all the EF (+) ASD (-) patients were three. The scores were (2.7 + 1.8), (22 + 1.9), (24.4 + 9)%, EF (-) ASD (+) patients were (2.9 + 1.5), (21.6 + 2), (25.7 + 8.7)%, respectively, and the difference showed good statistical value (P0.05) compared with EF (+) ASD (1.7 +)%, and (P0.05)%, respectively. Conclusion a retrospective study of this subject 167 cases of single segment lumbar degenerative disease treated with PLIF vertebral lamina osteotomy and PLIF laminectomy were used for the treatment of single segment lumbar degenerative disease. The two methods had achieved ideal clinical therapeutic effects. Compared with PLIF laminectomy,.PLIF vertebral lamina osteotomy replanting had better clinical efficacy and lower postoperative EF and ASD incidence. The results can provide reference for the selection of surgical methods for single segment lumbar degenerative disease in the clinical practice of spinal surgery. It has important theoretical value and clinical significance for guiding the operation planning and reducing the incidence of postoperative complications.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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本文編號：2025953