成人退變性脊柱側(cè)彎長節(jié)段固定融合的近期療效評(píng)價(jià)
發(fā)布時(shí)間：2019-06-01 23:40
【摘要】：目的:評(píng)價(jià)長節(jié)段固定融合手術(shù)治療成人退變性脊柱側(cè)彎(ADS)的近期臨床療效,探索合理的治療方案。方法:選取江西省人民醫(yī)院骨一科在2012年1月-2016年6月收治的ADS患者29人,術(shù)前根據(jù)拍攝的站立位脊柱正側(cè)位片均測(cè)量側(cè)彎cobb角、腰椎前凸角,并記錄VAS評(píng)分、JOA評(píng)分、ODI指數(shù)。所有患者均采用后路椎弓根釘棒內(nèi)固定手術(shù),術(shù)中對(duì)出現(xiàn)神經(jīng)癥狀節(jié)段充分減壓。記錄手術(shù)時(shí)間、出血量、手術(shù)的相關(guān)并發(fā)癥情況。術(shù)后拍攝脊柱正側(cè)位片,對(duì)術(shù)后約1周側(cè)彎cobb角、腰椎前凸角進(jìn)行測(cè)量,并記錄術(shù)后1周VAS評(píng)分、JOA評(píng)分、ODI指數(shù)。出院后至門診定期復(fù)查攝脊柱正側(cè)位片,測(cè)量手術(shù)3月后側(cè)彎cobb角、腰椎前凸角,記錄VAS評(píng)分、JOA評(píng)分、ODI指數(shù)。對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:29例患者手術(shù)均順利完成,術(shù)后安全返回病房。術(shù)后患者腰痛明顯減輕,生活質(zhì)量明顯改善,下肢放射痛患者均不同程度減輕,間隙性跛行均得到改善,3例仍感覺原有的下肢區(qū)域麻木。其中2例術(shù)后出現(xiàn)切口滲液,給予抗感染無效,再次手術(shù)清創(chuàng)探查,考慮同種異體骨排斥反應(yīng),術(shù)中取出同種異體骨,術(shù)后切口愈合良好;其余患者未再行探查手術(shù),1例術(shù)中硬膜破裂,術(shù)中行硬膜修補(bǔ),術(shù)后出現(xiàn)腦脊液漏;另還有1例出現(xiàn)腦脊液漏,予以延長引流時(shí)間,頭低腳高體位、壓迫傷口,并定期予以傷口換藥,切口愈合良好。1例術(shù)后出現(xiàn)呼吸困難,請(qǐng)相關(guān)科室會(huì)診,完善肺動(dòng)脈造影考慮為肺動(dòng)脈分支的終末支栓塞,治療后恢復(fù)良好。3例出現(xiàn)肺部感染,經(jīng)抗感染后明顯好轉(zhuǎn)。1例出現(xiàn)泌尿系感染,予以抗感染后情況好轉(zhuǎn)。術(shù)后1周與手術(shù)前相比,術(shù)后1周側(cè)彎cobb角、腰椎前凸角明顯糾正(P0.05),術(shù)后1周VAS評(píng)分、JOA評(píng)分及ODI指數(shù)較術(shù)前有明顯提升(P0.05)。術(shù)后3個(gè)月與術(shù)后1周相比,術(shù)后3個(gè)月側(cè)彎cobb角有輕度丟失(P0.05),腰椎前凸角無明顯變化(P0.05),術(shù)后3個(gè)月時(shí)與術(shù)后1周相比,術(shù)后3個(gè)月VAS評(píng)分、JOA評(píng)分、ODI指數(shù)改善明顯(P0.05)。結(jié)論:對(duì)于側(cè)彎角度較大、存在一定功能障礙的ADS患者,選用長節(jié)段固定手術(shù)近期的腰背痛可明顯減輕,下肢功能可得到明顯改善;對(duì)于恢復(fù)脊柱的矢狀面腰椎前凸角、冠狀面平衡作用明顯。
[Abstract]:Objective: to evaluate the short-term clinical effect of long segment fixation fusion surgery in the treatment of adult degenerative scoliosis (ADS) and to explore a reasonable treatment scheme. Methods: from January 2012 to June 2016, 29 patients with ADS were treated in the Department of Bone, Jiangxi Provincial people's Hospital. the cobb angle and lumbar protruding angle of lumbar vertebrae were measured according to the anterior and lateral films of standing position before operation, and the VAS score and JOA score were recorded. ODI index. All patients were treated with posterior pedicle screw internal fixation, and the segments with neurological symptoms were fully decompressed during the operation. The operation time, the amount of bleeding and the complications related to the operation were recorded. The cobb angle and lumbar kyphosis angle were measured at about 1 week after operation, and the VAS score, JOA score and ODI index were recorded one week after operation. After discharge from hospital to outpatient department, the anterior and lateral films of spine were taken regularly. Cobb angle and lumbar protruding angle were measured after 3 months of operation. VAS score, JOA score and ODI index were recorded. The results were analyzed statistically. Results: all the 29 patients completed the operation successfully and returned to the ward safely after operation. After operation, low back pain was significantly alleviated, quality of life was significantly improved, radiation pain of lower extremity was alleviated in varying degrees, intermittent claudication was improved, and 3 cases still felt numbness of lower extremity area. Among them, 2 cases had incision exudation after operation, which was ineffective in anti-infection, debridement and exploration again, considered allogenic bone rejection, and took out allogenic bone during operation, and the incision healed well after operation. No further exploration operation was performed in the other patients. 1 case underwent dural rupture during operation, dural repair was performed during operation, and cerebrospinal fluid leakage occurred after operation. In addition, cerebrospinal fluid leakage occurred in 1 case. The drainage time was prolonged, the head was low and the foot was high, the wound was pressed, and the wound was changed regularly. The incision healed well. 1 case had dyspnea after operation, please consult the relevant departments. Pulmonary angiography was considered as the terminal branch embolism of pulmonary artery branch, and recovered well after treatment. 3 cases had pulmonary infection, which was obviously improved after anti-infection. 1 case had urinary tract infection, and the condition was improved after anti-infection. Compared with before operation, the cobb angle and lumbar protruding angle were significantly corrected 1 week after operation (P 0.05). The VAS score, JOA score and ODI index 1 week after operation were significantly higher than those before operation (P 0.05). Compared with 1 week after operation, the cobb angle of lateral bending was slightly lost at 3 months after operation (P 0.05), but there was no significant change in lumbar protruding angle (P 0.05). Compared with 1 week after operation, VAS score and JOA score at 3 months after operation were not significantly changed (P 0.05). ODI index improved significantly (P 0.05). Conclusion: for ADS patients with large lateral bending angle and certain dysfunction, the short-term low back pain and lower extremity function can be obviously alleviated by long segment fixation. For the restoration of sagittal lumbar protruding angle, coronal balance is obvious.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
本文編號(hào)：2490669
[Abstract]:Objective: to evaluate the short-term clinical effect of long segment fixation fusion surgery in the treatment of adult degenerative scoliosis (ADS) and to explore a reasonable treatment scheme. Methods: from January 2012 to June 2016, 29 patients with ADS were treated in the Department of Bone, Jiangxi Provincial people's Hospital. the cobb angle and lumbar protruding angle of lumbar vertebrae were measured according to the anterior and lateral films of standing position before operation, and the VAS score and JOA score were recorded. ODI index. All patients were treated with posterior pedicle screw internal fixation, and the segments with neurological symptoms were fully decompressed during the operation. The operation time, the amount of bleeding and the complications related to the operation were recorded. The cobb angle and lumbar kyphosis angle were measured at about 1 week after operation, and the VAS score, JOA score and ODI index were recorded one week after operation. After discharge from hospital to outpatient department, the anterior and lateral films of spine were taken regularly. Cobb angle and lumbar protruding angle were measured after 3 months of operation. VAS score, JOA score and ODI index were recorded. The results were analyzed statistically. Results: all the 29 patients completed the operation successfully and returned to the ward safely after operation. After operation, low back pain was significantly alleviated, quality of life was significantly improved, radiation pain of lower extremity was alleviated in varying degrees, intermittent claudication was improved, and 3 cases still felt numbness of lower extremity area. Among them, 2 cases had incision exudation after operation, which was ineffective in anti-infection, debridement and exploration again, considered allogenic bone rejection, and took out allogenic bone during operation, and the incision healed well after operation. No further exploration operation was performed in the other patients. 1 case underwent dural rupture during operation, dural repair was performed during operation, and cerebrospinal fluid leakage occurred after operation. In addition, cerebrospinal fluid leakage occurred in 1 case. The drainage time was prolonged, the head was low and the foot was high, the wound was pressed, and the wound was changed regularly. The incision healed well. 1 case had dyspnea after operation, please consult the relevant departments. Pulmonary angiography was considered as the terminal branch embolism of pulmonary artery branch, and recovered well after treatment. 3 cases had pulmonary infection, which was obviously improved after anti-infection. 1 case had urinary tract infection, and the condition was improved after anti-infection. Compared with before operation, the cobb angle and lumbar protruding angle were significantly corrected 1 week after operation (P 0.05). The VAS score, JOA score and ODI index 1 week after operation were significantly higher than those before operation (P 0.05). Compared with 1 week after operation, the cobb angle of lateral bending was slightly lost at 3 months after operation (P 0.05), but there was no significant change in lumbar protruding angle (P 0.05). Compared with 1 week after operation, VAS score and JOA score at 3 months after operation were not significantly changed (P 0.05). ODI index improved significantly (P 0.05). Conclusion: for ADS patients with large lateral bending angle and certain dysfunction, the short-term low back pain and lower extremity function can be obviously alleviated by long segment fixation. For the restoration of sagittal lumbar protruding angle, coronal balance is obvious.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3
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