【摘要】：目的:探討流程優(yōu)化后腰椎后路椎管減壓椎體間融合術(shù)治療腰椎退行性疾病的安全性和有效性。方法:將收集到的符合納入標(biāo)準(zhǔn)的需行腰椎后路椎管減壓椎體間融合術(shù)的成年患者病例進(jìn)行回顧性分析。按照手術(shù)方式的不同,分為流程優(yōu)化組(59例)及傳統(tǒng)融合組(60例),再根據(jù)融合節(jié)段數(shù)分為三組:單節(jié)段、雙節(jié)段和2個(gè)節(jié)段。分別記錄患者的術(shù)中出血量、術(shù)后引流量、輸血量、紅細(xì)胞比容、術(shù)后并發(fā)癥(切口感染、神經(jīng)根損傷、硬脊膜損傷)、手術(shù)前后VAS及JOA評(píng)分、Macnab療效分級(jí)的等級(jí)例數(shù)、術(shù)后融合率及鄰近節(jié)段退變發(fā)生數(shù)。采用SPSS17.0統(tǒng)計(jì)軟件對(duì)上述資料進(jìn)行統(tǒng)計(jì)分析。結(jié)果:(1)組內(nèi)比較:同組內(nèi)各亞組間術(shù)中出血量、術(shù)后引流量、隱性失血量與輸血量均差異存在統(tǒng)計(jì)學(xué)意義(P0.05);同組內(nèi)各亞組間末次隨訪時(shí)VAS及JOA評(píng)分均較術(shù)前明顯改善(P0.05),但手術(shù)前、后VAS及JOA評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);隨著融合節(jié)段的增加,同組各亞組間并發(fā)癥及融合率無(wú)明顯差異,但2個(gè)節(jié)段組鄰近節(jié)段退變發(fā)生率高于其它兩個(gè)亞組。(2)組間比較:所有患者均獲得良好的隨訪;兩組間同節(jié)段亞組術(shù)中出血量、術(shù)后引流量、隱性失血量與輸血量均差異存在統(tǒng)計(jì)學(xué)意義(P0.05);在手術(shù)前后VAS及JOA評(píng)分、Macnab療效分級(jí)優(yōu)良率方面,兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);并發(fā)癥方面,傳統(tǒng)融合術(shù)中硬脊膜損傷及術(shù)后3d下肢神經(jīng)功能障礙高于流程優(yōu)化組;兩組患者術(shù)后均獲得良好的融合率,但流程優(yōu)化組術(shù)后鄰近節(jié)段退變發(fā)生率明顯低于傳統(tǒng)融合組。結(jié)論:流程優(yōu)化后腰椎后路減壓椎體間融合術(shù)與傳統(tǒng)融合術(shù)治療腰椎退行性疾病均是行之有效的治療方案,但流程優(yōu)化后腰椎后路減壓椎體間融合術(shù)對(duì)軟組織及骨性結(jié)構(gòu)破壞小、出血少,不僅能夠解決血源緊張的態(tài)勢(shì),還可以降低神經(jīng)根及硬脊膜損傷發(fā)生率,減緩術(shù)后鄰近節(jié)段退變的速度。
[Abstract]:Objective: to evaluate the safety and efficacy of posterior lumbar decompression and interbody fusion in the treatment of lumbar degenerative diseases. Methods: the collected adult patients with lumbar spinal canal decompression and interbody fusion were retrospectively analyzed. According to the different operation methods, they were divided into two groups: flow optimization group (59 cases) and traditional fusion group (60 cases). According to the number of fusion segments, they were divided into three groups: single segment, double segment and two segments. The intraoperative bleeding volume, postoperative drainage volume, blood transfusion volume, specific volume of red blood cells, postoperative complications (incision infection, nerve root injury, dural injury), VAS and JOA scores before and after operation, and the number of Macnab grade were recorded respectively. The rate of postoperative fusion and the incidence of adjacent segment degeneration. The above data were analyzed by SPSS17.0 software. Results: (1) Intra-group comparison: there were significant differences in intraoperative blood loss, postoperative drainage volume, recessive blood loss and blood transfusion volume among subgroups in the same group (P0.05). The scores of VAS and JOA at the last follow-up in the same group were significantly improved compared with those before operation (P0.05), but there was no significant difference in VAS and JOA scores before and after operation (P0.05). With the increase of fusion segments, there was no significant difference in complications and fusion rates among subgroups of the same group, but the incidence of degeneration of adjacent segments in the two subgroups was higher than that in the other two subgroups. (2) comparison between groups: all the patients were followed up well; There were significant differences in intraoperative blood loss, postoperative drainage volume, recessive blood loss and blood transfusion volume between the two groups (P0.05). There was no significant difference between the two groups in the scores of VAS and JOA before and after operation and the excellent and good rate of Macnab grade (P0.05), the complications of the two groups were higher than those in the traditional fusion group in dural injury and lower extremity neurological dysfunction 3 days after operation. Good fusion rate was obtained in both groups, but the incidence of postoperative adjacent segment degeneration in the process optimization group was significantly lower than that in the traditional fusion group. Conclusion: both posterior decompression and interbody fusion are effective in the treatment of lumbar degenerative diseases. But the posterior decompression and interbody fusion of lumbar vertebrae can not only solve the situation of blood tension, but also reduce the incidence of nerve root and dural injury. The degenerative rate of adjacent segment after operation was slowed down.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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