發(fā)布時間：2018-08-12 09:24

【摘要】：背景:后路椎體間融合手術(shù)治療退變性腰椎失穩(wěn)癥是臨床應用較為普遍的一種方法。經(jīng)典的術(shù)式是雙枚椎間融合器進行椎間融合,其要求操作空間大,術(shù)野開闊,雙側(cè)關(guān)節(jié)突難以保留,容易破壞脊柱后方結(jié)構(gòu)、椎旁肌群及椎管內(nèi)組織,并且手術(shù)時間較長、術(shù)中出血量大、花費高。因此,有必要尋求一種可以減少后柱結(jié)構(gòu)及椎旁肌肉的破壞性,而又不減少椎間融合率的有利方法,更好地為臨床工作服務。目的:對比分析單枚與雙枚椎間融合器在退變性腰椎失穩(wěn)癥后路椎體間融合手術(shù)中的治療效果,更好地為臨床工作服務。材料與方法:自2011年8月至2013年12月,選取山東省文登整骨醫(yī)院脊柱脊髓科行單節(jié)段后路減壓椎間融合內(nèi)固定治療退變性腰椎失穩(wěn)癥的手術(shù)患者共198例,按使用Cage的數(shù)目將其分為單枚組(A組,110例)與雙枚組(B組,88例)進行嚴格隨訪、跟蹤,獲得其術(shù)后兩年或兩年以上的臨床及影像學資料進行比對、分析。結(jié)果:兩組病例間的年齡、性別、發(fā)病節(jié)段、術(shù)后隨訪時間的差別無統(tǒng)計學意義(P0.05),A組病例中的手術(shù)時間、術(shù)中出血量、平均住院花費低于B組(P0.05),兩組病例術(shù)后JOA評分、ODI評分、椎間融合率、椎間隙高度的差異均無統(tǒng)計學意義(P0.05)。結(jié)論:單、雙枚椎間融合器治療退變性腰椎失穩(wěn),均可達到滿意效果。而與雙枚椎間融合器相比,單枚融合器植入操作要求簡單,手術(shù)創(chuàng)傷小,可更大程度保留脊柱后方結(jié)構(gòu),由于少用一枚融合器,花費更少。
[Abstract]:Background: posterior interbody fusion is a common method in the treatment of degenerative lumbar instability. The classical operation is to perform intervertebral fusion with two intervertebral fusion cages, which require large operation space, open surgical field, difficult to preserve bilateral articular processes, easily destroy the posterior structure of the spine, paraspinal muscle group and intraspinal tissue, and have a longer operation time. The amount of intraoperative bleeding is large and the cost is high. Therefore, it is necessary to find a method that can reduce the destructiveness of posterior column structure and paraspinal muscles without reducing the rate of intervertebral fusion, so as to serve the clinical work better. Objective: to compare and analyze the effect of single and double interbody fusion cage in posterior interbody fusion of degenerative lumbar instability. Materials and methods: from August 2011 to December 2013, 198 patients with degenerative lumbar instability were selected from Department of Spine and Spinal Cord, Wendeng whole Bone Hospital of Shandong Province, who were treated with single segment posterior decompression and interbody fusion and internal fixation. According to the number of Cage, they were divided into single group (group A, n = 110) and double group (group B, n = 88). Results: there was no significant difference between the two groups in age, sex, level of onset, postoperative follow-up time (P0.05). The operative time, intraoperative bleeding volume, average hospitalization cost were lower in group A than those in group B (P0.05), and the JOA scores of two groups were significantly lower than those in group B (P0.05). There was no significant difference in intervertebral fusion rate and intervertebral space height (P0.05). Conclusion: both single and double interbody fusion cages can achieve satisfactory results in the treatment of degenerative lumbar instability. Compared with two intervertebral fusion cages, the single fusion cage requires simple operation, less surgical trauma, and can preserve the posterior structure of the spine to a greater extent, because of the less use of one fusion cage, the cost is even less.
【學位授予單位】：山東中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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