發(fā)布時間：2018-05-19 13:47

  本文選題：單側(cè) + 雙側(cè)��； 參考：《山西醫(yī)科大學》2015年碩士論文

【摘要】：目的:比較單側(cè)與雙側(cè)TLIF術(shù)治療單節(jié)段腰椎退行性疾病的中長期臨床療效方法:回顧性分析我院2007年3月至2010年3月因單節(jié)段腰椎退行性疾病入院患者共171例,依據(jù)納入標準分為腰椎單側(cè)椎弓根螺釘固定結(jié)合TLIF術(shù)組及雙側(cè)椎弓根螺釘固定結(jié)合TLIF術(shù)組。單側(cè)組患者79例,其中76例獲得隨訪,男37例,女39例,年齡25-65歲,平均45.32歲.雙側(cè)組患者92例,其中87例獲得隨訪,男性49例,女性38例,年齡26-70歲,平均50.13歲。所有患者術(shù)前均完善腰椎X線、CT及MRI檢查,由同一組醫(yī)師行單側(cè)或雙側(cè)椎弓根螺釘固定聯(lián)合TLIF術(shù),記錄手術(shù)操作時間、術(shù)中傷口出血量、術(shù)后傷口引流量及住院天數(shù)。采用日本骨科學會(JOA)評分法、疼痛視覺模擬評分(VAS)評估患者術(shù)前、術(shù)后三月及末次隨訪療效及疼痛情況,通過影像學測量手術(shù)節(jié)段椎間隙高度,并評估末次隨訪時椎體間融合情況以及分析相關(guān)并發(fā)癥。結(jié)果:患者隨訪時間5-8年,平均6.8年,單側(cè)組與雙側(cè)組在手術(shù)時間、術(shù)中出血量、術(shù)后引流量及住院時間有顯著差異(P0.05)。JOA及VAS評分單側(cè)組與雙側(cè)組比較無顯著差異(P0.05),術(shù)前與末次隨訪差異有統(tǒng)計學意義(P0.05).單側(cè)組與雙側(cè)組在同一時間點手術(shù)前后椎間隙高度差異無統(tǒng)計學意義(P0.05)但末次隨訪時病變間隙高度與手術(shù)前比較有明顯差異,且差異具有統(tǒng)計學意義(P0.05)。末次隨訪融合率單側(cè)組與雙側(cè)組無顯著差異(P0.05)。未發(fā)現(xiàn)椎弓根螺釘松動、脫出、斷釘?shù)惹闆r發(fā)生。結(jié)論:單側(cè)椎弓根螺釘內(nèi)固定聯(lián)合TLIF與雙側(cè)固定在治療單節(jié)段腰椎退行性疾病中長期臨床療效均滿意,單側(cè)TLIF更具有手術(shù)時間短、術(shù)中出血少、住院時間短等優(yōu)點,是治療單階段腰椎退行性疾病的較好選擇,但手術(shù)適應癥我們應嚴格掌握。
[Abstract]:Objective: To compare the medium and long term clinical efficacy of unilateral and bilateral TLIF in the treatment of single segment lumbar degenerative disease: a retrospective analysis of 171 patients admitted to the hospital from March 2007 to March 2010 with single segment lumbar degenerative disease was divided into unilateral lumbar pedicle screw fixation combined with TLIF and bilateral pedicle screw according to the inclusion criteria. There were 79 cases in one side group, of which 76 cases were followed up in one side group, including 37 men, 39 women, 25-65 years old and 45.32 years old. There were 92 cases in bilateral group, of which 87 were followed up, 49 men, 38 women, 26-70 years of age and average age. All patients improved the lumbar X ray, CT and MRI examination before operation, and the single side was performed by the same group of doctors. Or bilateral pedicle screw fixation combined with TLIF, the operation time, the amount of bleeding in the operation, the postoperative wound flow rate and the number of days in hospital were recorded. The Japanese Department of orthopedics Society (JOA) scoring method and the pain visual analogue score (VAS) were used to evaluate the effect and pain of the patients before and after the March and last follow-up, and the surgical section was measured by imaging. Intervertebral height, interbody fusion and related complications were evaluated at the last follow-up. Results: patients were followed up for 5-8 years, averaging 6.8 years. There was significant difference between unilateral group and bilateral group at operation time, intraoperative bleeding volume, postoperative flow rate and time of hospitalization (P0.05), there was no significant difference in.JOA and VAS scores between unilateral and bilateral groups (P 0.05) there was significant difference between the preoperative and the last follow-up (P0.05). There was no significant difference in the height of the intervertebral space between the unilateral and bilateral groups before and after the same time point (P0.05), but there was a significant difference in the height of the diseased space between the two groups at the last follow-up, and the difference was statistically significant (P0.05). There was no significant difference in bilateral group (P0.05). There was no discovery of pedicle screw loosening, release, and nail breaking. Conclusion: unilateral pedicle screw internal fixation combined with TLIF and bilateral fixation in the treatment of single segment lumbar degenerative disease is satisfactory, and unilateral TLIF has the advantages of short operation time, less bleeding during operation, short hospital time and so on. It is a good choice for the treatment of lumbar degenerative disease at one stage, but we should strictly grasp the indication.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：1910342