退行性腰椎側(cè)凸后路長節(jié)段固定不同上端固定椎選擇比較的研究
發(fā)布時間：2018-10-21 17:14
【摘要】：目的 對退行性腰椎側(cè)凸(Degenerative Lumbar Scoliosis, DLS)后路長節(jié)段融合內(nèi)固定不同上端固定椎選擇進(jìn)行研究,探討不同上端固定椎對臨床療效的影響。 方法 回顧分析2008年至2014年期間在本科室進(jìn)行后路長節(jié)段融合內(nèi)固定治療退行性腰椎側(cè)凸患者,根據(jù)術(shù)前術(shù)后全脊柱攝片不同上端固定椎,分為A,B兩組：A組特點為融合至上胸椎(upper thoracic, UT)(T10及以上),B組特點為融合至下胸椎(lower thoracic, LT)(T10以下)。平均融合節(jié)段分別為：8.5和5.6.分別記錄兩組手術(shù)操作時間(min),術(shù)中出血量(m1),術(shù)前與術(shù)后Cobb角,術(shù)前與術(shù)后Oswestry功能障礙指數(shù)評分(oswestry disability index, ODI),術(shù)前與術(shù)后胸椎后凸角(thoracic kyphosis, TK),術(shù)前與術(shù)后腰椎前凸角(lumbar lordosis, LL),術(shù)前與術(shù)后交界性后凸角(proximal junctional kyphosis, PJK),術(shù)前與術(shù)后矢狀位垂直軸(sagittal verticalaxis, SVA),術(shù)前與術(shù)后骨盆傾斜角(pelvic title, PT),并統(tǒng)計與分析兩組術(shù)后并發(fā)癥的發(fā)生率。 結(jié)果 共有30例符合條件的病例入組本研究,其中男13例,女17例,其中選擇上端胸椎為固定椎(upper thoracic,UT)記為A組15例,選擇下端胸椎為固定椎(lower thoracic,LT)B組15例,A組手術(shù)年齡66.4±6.5歲,B組手術(shù)年齡68.4±5.1歲,成人退行性腰椎側(cè)凸后路長節(jié)段融合內(nèi)固定選擇上胸椎與選擇下胸椎相比,A組手術(shù)操作時間(380.8±20.3mmin)比B組操作時間(240.8±10.3min)更長[P0.05],A組術(shù)中出血(1658.7±201.1m1)比B組術(shù)中出血(1325.8±101.2m1)更多[P0.05],兩組術(shù)后Oswestry功能障礙指數(shù)評分(oswestry disability index,ODI)較術(shù)前相比[P0.05]和有[P0.05]均有明顯改善,差異有統(tǒng)計學(xué)意義。兩組術(shù)后ODI評分[P=0.15]相比,差異無明顯統(tǒng)計學(xué)意義。兩組術(shù)后Cobb角較術(shù)前相比[P0.01]和有[P0.01]明顯改善,差異有統(tǒng)計學(xué)意義。兩組術(shù)后Cobb角[P=0..48]相比,差異無統(tǒng)計學(xué)意義。兩組胸椎后凸角(thoracic kyphosis,TK)[P=0.68],術(shù)后交界性后凸角(proximaljunctional kyphosis,PJK)[P=0.25],術(shù)后腰椎前凸角(lumbar lordosis,LL)[P=0.45],術(shù)后矢狀位垂直軸(sagittal vertical axis,SVA)[P=0.21],術(shù)后骨盆傾斜角(pelvic title,PT)[P=0.58]相比,差異均無統(tǒng)計學(xué)意義。 結(jié)論 對退行性腰椎側(cè)凸長節(jié)段固定患者,選擇T10為近端固定椎能達(dá)到與T10以上椎相似的脊柱矢狀面參數(shù)矯正效果,且具有手術(shù)時間短、出血量少的優(yōu)勢。
[Abstract]:Objective to study the choice of long segment fusion internal fixation for different upper end fixation of degenerative lumbar scoliosis (Degenerative Lumbar Scoliosis, DLS), and to explore the effect of different upper fixation on clinical efficacy. Methods from 2008 to 2014, the patients with degenerative lumbar scoliosis were treated with posterior long segment fusion and internal fixation. Group A was divided into two groups: group A was characterized by fusion of upper thoracic vertebra (upper thoracic, UT) (T10 and), B group with fusion to lower thoracic vertebra (lower thoracic, LT) (T10. The mean fusion segments were 8.5 and 5.6, respectively. Blood loss (M1), preoperative and postoperative Cobb angles were recorded in two groups during (min), operation. Preoperative and postoperative Oswestry dysfunction Index score (oswestry disability index, ODI), preoperative and postoperative thoracic kyphosis angle (thoracic kyphosis, TK), preoperative and postoperative lumbar kyphosis angle (lumbar lordosis, LL), preoperative and postoperative borderline kyphosis angle (proximal junctional kyphosis, PJK), preoperative and postoperative sagittal vertical axis The incidence of postoperative complications was analyzed by (pelvic title, PT), before and after (sagittal verticalaxis, SVA),. Results A total of 30 eligible cases were included in this study, including 13 males and 17 females. The upper thoracic vertebra was selected as fixed vertebra (upper thoracic,UT) in group A (15 cases). The lower thoracic vertebra was selected as the fixed vertebra (lower thoracic,LT) group B (15 cases). The operative age of group A was 66.4 鹵6.5 years old, and that of group B was 68.4 鹵5.1 years old. The operative time of group A (380.8 鹵20.3mmin) was longer than that of group B (240.8 鹵10.3min), the operative time of group A (1658.7 鹵201.1m1) was more than that of group B (1325.8 鹵101.2m1) [P0.05]. The scores of Oswestry dysfunction index (oswestry disability index,ODI) in group A were significantly improved compared with those before [P0.05] and (P0.05). The difference is statistically significant. There was no significant difference in ODI score between the two groups. The postoperative Cobb angle of the two groups was significantly improved compared with the preoperative ones (P 0.01 and P 0.01). There was no significant difference in Cobb angle between the two groups. There was no significant difference in thoracic kyphosis angle (thoracic kyphosis,TK), borderline kyphosis angle (proximaljunctional kyphosis,PJK), lumbar spine kyphosis angle (lumbar lordosis,LL), sagittal vertical axis (sagittal vertical axis,SVA) and pelvic obliquity angle (pelvic title,PT) between the two groups. Conclusion for the patients with long segmental degenerative lumbar scoliosis, the choice of T10 as proximal fixation can achieve the correction effect of sagittal parameters similar to that of T10, and has the advantages of short operation time and less bleeding.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：2285802
[Abstract]:Objective to study the choice of long segment fusion internal fixation for different upper end fixation of degenerative lumbar scoliosis (Degenerative Lumbar Scoliosis, DLS), and to explore the effect of different upper fixation on clinical efficacy. Methods from 2008 to 2014, the patients with degenerative lumbar scoliosis were treated with posterior long segment fusion and internal fixation. Group A was divided into two groups: group A was characterized by fusion of upper thoracic vertebra (upper thoracic, UT) (T10 and), B group with fusion to lower thoracic vertebra (lower thoracic, LT) (T10. The mean fusion segments were 8.5 and 5.6, respectively. Blood loss (M1), preoperative and postoperative Cobb angles were recorded in two groups during (min), operation. Preoperative and postoperative Oswestry dysfunction Index score (oswestry disability index, ODI), preoperative and postoperative thoracic kyphosis angle (thoracic kyphosis, TK), preoperative and postoperative lumbar kyphosis angle (lumbar lordosis, LL), preoperative and postoperative borderline kyphosis angle (proximal junctional kyphosis, PJK), preoperative and postoperative sagittal vertical axis The incidence of postoperative complications was analyzed by (pelvic title, PT), before and after (sagittal verticalaxis, SVA),. Results A total of 30 eligible cases were included in this study, including 13 males and 17 females. The upper thoracic vertebra was selected as fixed vertebra (upper thoracic,UT) in group A (15 cases). The lower thoracic vertebra was selected as the fixed vertebra (lower thoracic,LT) group B (15 cases). The operative age of group A was 66.4 鹵6.5 years old, and that of group B was 68.4 鹵5.1 years old. The operative time of group A (380.8 鹵20.3mmin) was longer than that of group B (240.8 鹵10.3min), the operative time of group A (1658.7 鹵201.1m1) was more than that of group B (1325.8 鹵101.2m1) [P0.05]. The scores of Oswestry dysfunction index (oswestry disability index,ODI) in group A were significantly improved compared with those before [P0.05] and (P0.05). The difference is statistically significant. There was no significant difference in ODI score between the two groups. The postoperative Cobb angle of the two groups was significantly improved compared with the preoperative ones (P 0.01 and P 0.01). There was no significant difference in Cobb angle between the two groups. There was no significant difference in thoracic kyphosis angle (thoracic kyphosis,TK), borderline kyphosis angle (proximaljunctional kyphosis,PJK), lumbar spine kyphosis angle (lumbar lordosis,LL), sagittal vertical axis (sagittal vertical axis,SVA) and pelvic obliquity angle (pelvic title,PT) between the two groups. Conclusion for the patients with long segmental degenerative lumbar scoliosis, the choice of T10 as proximal fixation can achieve the correction effect of sagittal parameters similar to that of T10, and has the advantages of short operation time and less bleeding.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 夏良政;徐宏光;;退變性脊柱側(cè)彎自然史與治療[J];國際骨科學(xué)雜志;2006年03期
2 王智方;胡偵明;郝杰;陳林;汪禮軍;張曉軍;甘強(qiáng);何斌;;經(jīng)椎弓根內(nèi)固定治療退行性腰椎側(cè)凸并椎管狹窄癥[J];中國組織工程研究;2014年17期
，本文編號：2285802
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