發(fā)布時間：2018-06-16 16:21

  本文選題：腰椎間盤突出癥 + Luxor通道管系統(tǒng)　； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的：腰椎間盤突出癥是骨科的常見病之一。本癥首選的治療方案為保守治療，當(dāng)保守治療無效時行手術(shù)治療，傳統(tǒng)的術(shù)式多采用開放性手術(shù)，，近年來，隨著微創(chuàng)技術(shù)在脊柱外科手術(shù)中的開展，通道系統(tǒng)已應(yīng)用于臨床治療中，輔以影像學(xué)的個體化術(shù)前設(shè)計(jì)也得到越來越多的關(guān)注。本研究比較了LUXOR可擴(kuò)張通道系統(tǒng)與傳統(tǒng)開放性手術(shù)在治療腰椎間盤突出癥的優(yōu)缺點(diǎn)，并探討影像學(xué)個性化術(shù)前設(shè)計(jì)的應(yīng)用價值。 方法：回顧性分析吉林大學(xué)第二醫(yī)院骨科醫(yī)院脊柱外科2013年8月～2014年12月收治的29例單節(jié)段腰椎間盤突出癥患者，其中9例采用LUXOR可擴(kuò)張通道管系統(tǒng)治療設(shè)立為觀察組，其余20例行傳統(tǒng)開放式手術(shù)設(shè)為對照組。對兩組病例的切口長度、術(shù)中出血量、手術(shù)時間、術(shù)后下床活動時間、住院時間、有無并發(fā)癥發(fā)生和術(shù)后下腰部疼痛進(jìn)行比較，全部患者均由同一位教授完成手術(shù)操作，且上述29例患者的VAS、JOA和Macnab評分均由同一位醫(yī)師完成。 結(jié)果：切口長度（cm）：觀察組＜對照組；手術(shù)時間（min）：觀察組＜對照組；術(shù)后下床時間（d）：觀察組＜對照組；平均住院天數(shù)（d）：觀察組＜對照組；術(shù)后并發(fā)癥：觀察組＜對照組。以上各組比較，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。觀察組和對照組的術(shù)后下腰部疼痛差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。兩組術(shù)后Macnab療效優(yōu)良率差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 結(jié)論：1、微創(chuàng)通道下手術(shù)和傳統(tǒng)開放手術(shù)治療腰椎間盤突出癥的療效并無明顯統(tǒng)計(jì)學(xué)差異；2、嚴(yán)格掌握手術(shù)適應(yīng)證和禁忌癥的前提下，Luxor可擴(kuò)張通道管系統(tǒng)下進(jìn)行手術(shù)與傳統(tǒng)開放式手術(shù)對于腰椎間盤突出癥的治療均能解決神經(jīng)壓迫癥狀，達(dá)到預(yù)期效果，Luxor可擴(kuò)張通道系統(tǒng)下手術(shù)具有創(chuàng)傷小、出血少、切口小、功能恢復(fù)快和早期下床活動的特點(diǎn)；3、根據(jù)影像學(xué)資料進(jìn)行術(shù)前手術(shù)設(shè)計(jì)有助于精確定位、減少失誤。
[Abstract]:Objective: lumbar disc herniation is one of the common diseases in orthopaedics. The first choice of treatment for this disease is conservative treatment. When the conservative treatment is not effective, the traditional surgical methods are mostly open surgery. In recent years, with the development of minimally invasive techniques in spinal surgery, Channel system has been used in clinical treatment and individualized preoperative design with imaging has been paid more and more attention. This study compared the advantages and disadvantages of LUXOR expandable channel system with traditional open surgery in the treatment of lumbar disc herniation and discussed the application value of individualized preoperative design of imaging. Methods: a retrospective analysis of 29 patients with single segment lumbar disc herniation from August 2013 to December 2014 in Department of Spinal surgery, Orthopaedics Hospital, second Hospital of Jilin University was performed. Among them, 9 cases were treated with LUXOR expandable canal system as the observation group. The other 20 cases were treated with traditional open operation as control group. The length of incision, the amount of blood lost during operation, the time of getting out of bed, the time of hospitalization, the occurrence of complications and the pain of lower back after operation were compared between the two groups. All the patients were operated by the same professor. The VASV JOA and Macnab scores of 29 patients were performed by the same physician. Results: the length of incision was: observation group < control group; operation time: observation group < control group; postoperative time of getting out of bed: observation group < control group; average days of hospitalization: observation group < control group; postoperative complication: observation group < control group. The difference was statistically significant (P < 0.05). There was no significant difference in lower back pain between the observation group and the control group (P > 0.05). There was no significant difference in the effective rate of Macnab between the two groups (P > 0.05). Conclusion there is no significant difference in the curative effect between minimally invasive surgery and traditional open surgery in the treatment of lumbar disc herniation. 2. Under the premise of strictly mastering the indications and contraindications of surgery, both Luxor and traditional open surgery can solve the symptoms of nerve compression in the treatment of lumbar disc herniation. In order to achieve the desired results, Luxor can expand the system of surgery with less trauma, less bleeding, small incision, quick functional recovery and early movement out of bed. Preoperative surgical design based on imaging data is helpful for accurate location and reduction of errors.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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