本文選題：腰椎管狹窄 + 椎板截骨�。� 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的通過(guò)臨床及影像學(xué)評(píng)價(jià)椎板切除潛行減壓椎板回植術(shù)治療腰椎管狹窄的療效及再植椎板兩種固定材料的差異。方法選取唐山二院脊柱一科2014年8月至2016年1月期間,采用椎板切除潛行減壓椎板回植輸治療的73例腰椎間盤(pán)突出癥伴腰椎管狹窄及腰椎管狹窄癥患者,47例椎板回植后采用絲線固定,26例采用鈦板固定。運(yùn)用JOA、腰腿痛VAS評(píng)分,評(píng)價(jià)絲線固定及鈦板固定臨床效果及對(duì)比兩種固定對(duì)臨床效果的影響。影像學(xué)方面隨訪通過(guò)腰椎X線正側(cè)位、CT、屈伸動(dòng)力位觀察術(shù)后椎管減壓情況、椎板再植愈合程度及術(shù)后硬膜外瘢痕情況,對(duì)比兩種固定材料術(shù)后影像學(xué)表現(xiàn)的差異性。結(jié)果73例患者中,69例患者獲得臨床療效隨訪,包括椎板再植絲線固定45人,隨訪時(shí)間18.2個(gè)月,椎板再植鈦板固定24例,隨訪時(shí)間14.4個(gè)月。絲線固定術(shù)后JOA評(píng)分升高、腰腿痛VAS評(píng)分降低,與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義(P0.05),末次隨訪優(yōu)良率達(dá)88.9%,鈦板固定術(shù)后JOA評(píng)分升高、腰、腿痛VAS評(píng)分降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),末次隨訪優(yōu)良率為91.7%。椎板再植絲線固定與鈦板固定術(shù)后相同時(shí)間點(diǎn)對(duì)比,鈦板固定術(shù)后3個(gè)月時(shí)JOA高于絲線固定,而3個(gè)月、6個(gè)月腰痛VAS低于絲線固定(P0.05),鈦板固定優(yōu)于絲線固定。60例患者獲得影像學(xué)隨訪,絲線固定37人,鈦板固定23人。絲線固定中再植椎板1例未愈合,6例為不全愈合,其余全部正常愈合,愈合時(shí)間為6-12月。鈦板固定中除1例因超聲骨刀截骨導(dǎo)致內(nèi)陷外其余全部正常愈合,愈合時(shí)間為3-6個(gè)月。愈合后截骨前緣未見(jiàn)過(guò)度增生產(chǎn)生新的壓迫和骨痂向椎管內(nèi)突出,截骨前緣光滑,硬膜囊充盈膨脹良好。椎管失狀徑、橫徑擴(kuò)大。修復(fù)的椎管有效的阻止了椎管外瘢痕組織向椎管內(nèi)移位。末次隨訪無(wú)腰痛加重及過(guò)伸過(guò)屈位無(wú)不穩(wěn)的發(fā)生。結(jié)論1椎板切除潛行減壓椎板回植是治療腰椎管狹窄一種有效術(shù)式,能解除壓迫改善臨床癥狀,同時(shí)修復(fù)了腰椎后部結(jié)構(gòu),有效的防止了腰椎不穩(wěn)及硬膜外瘢痕粘連等并發(fā)癥。2椎板再植后鈦板固定具有更可靠的牢固性,有利于再植椎板的穩(wěn)定及愈合。
[Abstract]:Objective to evaluate the effect of laminectomy with decompression and laminectomy in the treatment of lumbar spinal canal stenosis and the difference of two kinds of fixation materials. Methods from August 2014 to January 2016, the spine of the second Hospital of Tangshan was selected. Forty-seven patients with lumbar disc herniation with lumbar spinal canal stenosis and lumbar spinal canal stenosis were treated with laminectomy, decompression and laminectomy, and 26 patients were treated with titanium plate fixation after laminectomy. The clinical effects of wire fixation and titanium plate fixation were evaluated by using VAS score of JOAand lumbago and leg pain. Imaging follow-up was performed to observe the decompression of the spinal canal, the healing degree of laminar replantation and the epidural scar after operation by CT, flexion and extension dynamic position of lumbar vertebrae. The difference of imaging findings between the two kinds of fixation materials was compared. Results among 73 cases, 69 cases were followed up, including 45 cases of laminae replantation and wire fixation. The follow-up time was 18.2 months, 24 cases were fixed with titanium plate, and the follow-up time was 14.4 months. The JOA score increased and the VAS score of lumbago and leg pain decreased after silk thread fixation. The difference was statistically significant (P 0.05). The excellent and good rate of the last follow-up was 88.9%. The JOA score increased and the VAS score of lumbar and leg pain decreased after titanium plate fixation. The difference was statistically significant (P 0.05), and the excellent and good rate of the last follow-up was 91.7%. Compared with the same time points after laminectomy, the JOA of laminar replantation was higher than that of filamentous fixation at 3 months after laminectomy. In 3 months and 6 months, the VAS of lumbago was lower than that of wire fixation (P 0.05), and titanium plate fixation was superior to wire fixation in 60 cases. 37 cases were fixed with wire and 23 cases were fixed with titanium plate. In the filamentous fixation, 1 case of unhealed laminae was not healed completely, the rest healed normally, and the healing time was 6 months to 12 months. The healing time of titanium plate fixation was 3-6 months. No new compression and callus protruding into the spinal canal were found in the anterior edge of the osteotomy after healing. The anterior edge of the osteotomy was smooth and the dural sac filled and expanded well. The spinal canal is lost and the transverse diameter is enlarged. The repaired spinal canal effectively prevents the extramedullary scar tissue from moving into the spinal canal. No increase in low back pain and no instability in extension and flexion at the last follow-up. Conclusion 1 Laminectomy with decompression is an effective method for the treatment of lumbar spinal canal stenosis. It can relieve compression and improve clinical symptoms, and at the same time, it can repair the posterior structure of lumbar vertebrae. Effective prevention of complications such as lumbar instability and epidural scar adhesion. 2. Titanium plate fixation after lamina replantation is more reliable and reliable, which is beneficial to the stability and healing of the replanted lamina.
【學(xué)位授予單位】：華北理工大學(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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