腰椎懸浮固定與腰骶部固定術(shù)后鄰近節(jié)段退變的臨床研究
發(fā)布時間：2018-11-14 09:38
【摘要】：目的:對照研究懸浮固定與腰骶部固定兩種融合手術(shù)方式在治療腰骶椎退行性病變的中期臨床療效,以及術(shù)后對腰骶椎鄰近節(jié)段退變的影響。方法:回顧性分析研究廣東省中醫(yī)院骨一科在2010年1月至2014年12因腰骶椎退行性病變(腰椎間盤突出癥、腰椎管狹窄癥、退變性腰椎滑脫癥)的病人,選取符合納入條件患者共84例,其中腰椎懸浮固定組(觀察組)42例,腰骶部固定組(對照組)42例。通過采集術(shù)前及隨訪時的相關(guān)臨床資料,采用VAS、J0A評分標(biāo)準(zhǔn),評估兩種手術(shù)方式的臨床療效;通過收集術(shù)前及各個隨訪時間段的腰椎正側(cè)位、動力位X光片以及腰椎MRI,分別測量內(nèi)固定手術(shù)上位節(jié)段和下位節(jié)段的椎間隙高度(H)、腰椎活動度(ROM)、腰椎前凸角(LL)、骨盆入射角(PI)、術(shù)前骨盆入射角與腰椎前凸角差值(ΔPILL),再運用UCLA椎間隙退變分級標(biāo)準(zhǔn)在腰椎X光片上進(jìn)行分析評分。記錄兩組病例術(shù)前及末次隨訪時的各項指標(biāo)情況,使用EXCEL 2007軟件建立數(shù)據(jù)庫并用SPSS 21.0軟件進(jìn)行統(tǒng)計分析,比較兩組術(shù)前與末次隨訪時各項指標(biāo)組內(nèi)及組間的差異,當(dāng)P0.05被認(rèn)為具有統(tǒng)計學(xué)意義。結(jié)果:腰椎懸浮固定組(觀察組)與腰骶部固定組患者(對照組)的一般資料(年齡、性別、BMI、病程、手術(shù)時間、住院天數(shù)、隨訪時間、術(shù)中出血量、術(shù)前診斷)比較中無統(tǒng)計學(xué)差異(P0.05),基線平衡,提示兩組資料之間具有可比性。觀察組術(shù)前J0A評分、腰痛VAS評分、腿痛VAS評分分別是16.98±2.25、3.74±1.70、5.05土1.51,末次隨訪時為25.17±1.78、0.68±0.56、0.76±0.59,組內(nèi)差異性均有統(tǒng)計學(xué)意義(P0.01)。對照組術(shù)前J0A評分、腰痛VAS評分、腿痛VAS評分分別是 16.93土2.68、3.96土2.03、5.12±1.48,末次隨訪時為 24.97±1.65、0.67±0.60、0.83±0.56,組內(nèi)差異性均有統(tǒng)計學(xué)意義(P0.01)。在隨訪期間共有34例患者發(fā)生鄰近節(jié)段退變,平均發(fā)生于術(shù)后隨訪第24.50士12.95月。在觀察組中,ASDeg的發(fā)病率為26.19%(11/42),ASDis的發(fā)病率為19.05%(8/42),8例ASDis中僅有1例行再次手術(shù)治療。而在對照組中,ASDeg的發(fā)病率為4.76%(2/42),ASDis的發(fā)病率為30.95%(13/42),13例ASDis中有3例因明顯下肢放射性疼痛行翻修手術(shù),兩組間差異具有統(tǒng)計學(xué)意義(P0.05)�！鱌ILL的受試者工作特征曲線產(chǎn)生的AUC面積為0.797,提示ΔPILL對術(shù)后鄰近節(jié)段退變的診斷價值中等。當(dāng)最佳臨界點為19.1°時,對術(shù)后鄰近節(jié)段退變的靈敏度為85.7%,特異度為75.7%,陽性預(yù)測值為87.3%,陰性預(yù)測值為93.1%。以最佳臨界點為分組依據(jù),術(shù)前△PILL19.1°組有55例,術(shù)后有7例發(fā)生鄰近節(jié)段退變,發(fā)病率為12.7%;而術(shù)前△PILL19.1°組中,術(shù)后發(fā)生鄰近節(jié)段退變的患者有32例,發(fā)病率為93.1%。差異性有統(tǒng)計學(xué)意義(P0.01)。結(jié)論:腰椎懸浮固定與腰骶部固定兩種融合內(nèi)固定手術(shù)方式在治療腰骶部退行性病變上均可獲得良好的中期臨床療效,且兩者效果相當(dāng)。兩種術(shù)式在術(shù)后均發(fā)生不同程度的影像學(xué)鄰近節(jié)段退變,其中懸浮固定組的鄰近節(jié)段更容易發(fā)生影像學(xué)上的退變,但術(shù)后因退變所導(dǎo)致的下肢根性疼痛癥狀在腰骶部固定組更多見。術(shù)前骨盆入射角與腰椎前凸角差值更大的患者,術(shù)后更易于發(fā)生鄰近節(jié)段退變。
[Abstract]:Objective: To study the mid-term clinical effect of two fusion-operation methods in the treatment of the degenerative diseases of the lumbar intervertebral disc and the effect of the post-operation on the detransformation of the adjacent segment of the lumbar vertebra. Methods: The patients with degenerative lumbar disc disease (lumbar disc herniation, lumbar spinal stenosis, degenerative lumbar spondylolisthesis) from January 2010 to December 2014 were analyzed retrospectively, and 84 cases were selected according to the conditions of inclusion. Among them, 42 cases of the lumbar suspension fixation group (observation group) and 42 cases of the lumbar spinal fixation group (control group) were observed. The clinical efficacy of the two methods of operation was evaluated by using the VAS and J0A scoring criteria before and during the follow-up period, and the positive lateral position of the lumbar vertebra, the power position X-ray film and the lumbar vertebra MRI before and after the operation were collected. respectively measuring the intervertebral space height (H), the lumbar motion (ROM), the lumbar lordosis (LL), the pelvic angle of incidence (PI), the pre-operative pelvic angle of incidence and the lumbar lordosis (pILL) of the upper and lower segments of the internal fixation operation, and then the UCLA intervertebral space degrading standard is used for performing the analysis and grading on the lumbar vertebra X-ray film. The indexes of the two groups were recorded before and after the last follow-up. The database was established by using the EXCEL 2007 software and the statistical analysis was made with the SPSS 10.0 software. The difference between the two groups and the group was compared between the two groups before and after the last follow-up. Results: The general data (age, sex, BMI, course of course, operation time, number of days of stay, follow-up time, intraoperative blood loss, pre-operative diagnosis) of the lumbar suspension fixation group (observation group) and the fixed group of the lumbar vertebra (control group) were not statistically different (P0.05), and the baseline balance, Prompt for comparability between the two groups of data. The preoperative J0A score, the back pain VAS score and the leg pain VAS score of the observation group were 16.98, 2.25, 3.74, 1.70, 5.05, 1.51, and 25.17, 1.78, 0.68, 0.56, 0.76 and 0.59 in the last follow-up, respectively (P0.01). In the control group, the preoperative J0A score, the back pain VAS score and the leg pain VAS score were 16.93, 2.68, 3.96, 2.03, 5.12 and 1.48, and the difference in the group was 24.97, 1.65, 0.67, 0.60, 0.83 and 0.56, respectively (P0.01). In the follow-up period, a total of 34 patients had an adjacent segment withdrawal, with an average of 24. 50 + 12. 95 months follow-up. In the observation group, the incidence of ASDeg was 26. 19% (11/ 42), the incidence of ASDis was 19.05% (8/ 42), and only 1 of the 8 ASDs was treated again. In the control group, the incidence of ASDeg was 4.76% (2/ 42), the incidence of ASDis was 30. 95% (13/ 42), and 3 of the 13 ASDs were revision surgery due to the significant lower limb radioactive pain, and the difference between the two groups was statistically significant (P0.05). The area of the AUC generated by the subject's working characteristic curve for PILL was 0.797, suggesting a moderate value of the diagnostic value of pILL for the devariable of the adjacent segment after the procedure. When the optimal critical point was 19. 1 擄, the sensitivity of the devariable to the adjacent segment after operation was 85.7%, the specificity was 75.7%, the positive predictive value was 87.3%, and the negative predictive value was 93.1%. On the basis of the optimal critical point, there were 55 cases in the preoperatively PILL19. 1 degree group, 7 cases of the post-operative treatment of the adjacent segment and the incidence rate of 12.7%, and 32 of the patients with the adjacent segment after the operation, with the incidence of 93.1%. The difference was significant (P0.01). Conclusion: The two fusion internal fixation methods of the lumbar suspension fixation and the lumbar spinal fixation are effective in the treatment of the degenerative diseases of the lumbar intervertebral disc, and the effect is comparable. The two methods have different degree of image adjacent segment dedifferentiation after the operation, in which the adjacent segment of the suspended fixation group is more prone to image regression, but the symptoms of the lower limb radicular pain caused by the demotion after the operation are more commonly seen in the fixed group of the waist part. The pre-operative pelvic angle of incidence is greater than that of the lumbar lordosis, and it is easier for the post-operative to take place adjacent to the segment.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
，
本文編號：2330804
[Abstract]:Objective: To study the mid-term clinical effect of two fusion-operation methods in the treatment of the degenerative diseases of the lumbar intervertebral disc and the effect of the post-operation on the detransformation of the adjacent segment of the lumbar vertebra. Methods: The patients with degenerative lumbar disc disease (lumbar disc herniation, lumbar spinal stenosis, degenerative lumbar spondylolisthesis) from January 2010 to December 2014 were analyzed retrospectively, and 84 cases were selected according to the conditions of inclusion. Among them, 42 cases of the lumbar suspension fixation group (observation group) and 42 cases of the lumbar spinal fixation group (control group) were observed. The clinical efficacy of the two methods of operation was evaluated by using the VAS and J0A scoring criteria before and during the follow-up period, and the positive lateral position of the lumbar vertebra, the power position X-ray film and the lumbar vertebra MRI before and after the operation were collected. respectively measuring the intervertebral space height (H), the lumbar motion (ROM), the lumbar lordosis (LL), the pelvic angle of incidence (PI), the pre-operative pelvic angle of incidence and the lumbar lordosis (pILL) of the upper and lower segments of the internal fixation operation, and then the UCLA intervertebral space degrading standard is used for performing the analysis and grading on the lumbar vertebra X-ray film. The indexes of the two groups were recorded before and after the last follow-up. The database was established by using the EXCEL 2007 software and the statistical analysis was made with the SPSS 10.0 software. The difference between the two groups and the group was compared between the two groups before and after the last follow-up. Results: The general data (age, sex, BMI, course of course, operation time, number of days of stay, follow-up time, intraoperative blood loss, pre-operative diagnosis) of the lumbar suspension fixation group (observation group) and the fixed group of the lumbar vertebra (control group) were not statistically different (P0.05), and the baseline balance, Prompt for comparability between the two groups of data. The preoperative J0A score, the back pain VAS score and the leg pain VAS score of the observation group were 16.98, 2.25, 3.74, 1.70, 5.05, 1.51, and 25.17, 1.78, 0.68, 0.56, 0.76 and 0.59 in the last follow-up, respectively (P0.01). In the control group, the preoperative J0A score, the back pain VAS score and the leg pain VAS score were 16.93, 2.68, 3.96, 2.03, 5.12 and 1.48, and the difference in the group was 24.97, 1.65, 0.67, 0.60, 0.83 and 0.56, respectively (P0.01). In the follow-up period, a total of 34 patients had an adjacent segment withdrawal, with an average of 24. 50 + 12. 95 months follow-up. In the observation group, the incidence of ASDeg was 26. 19% (11/ 42), the incidence of ASDis was 19.05% (8/ 42), and only 1 of the 8 ASDs was treated again. In the control group, the incidence of ASDeg was 4.76% (2/ 42), the incidence of ASDis was 30. 95% (13/ 42), and 3 of the 13 ASDs were revision surgery due to the significant lower limb radioactive pain, and the difference between the two groups was statistically significant (P0.05). The area of the AUC generated by the subject's working characteristic curve for PILL was 0.797, suggesting a moderate value of the diagnostic value of pILL for the devariable of the adjacent segment after the procedure. When the optimal critical point was 19. 1 擄, the sensitivity of the devariable to the adjacent segment after operation was 85.7%, the specificity was 75.7%, the positive predictive value was 87.3%, and the negative predictive value was 93.1%. On the basis of the optimal critical point, there were 55 cases in the preoperatively PILL19. 1 degree group, 7 cases of the post-operative treatment of the adjacent segment and the incidence rate of 12.7%, and 32 of the patients with the adjacent segment after the operation, with the incidence of 93.1%. The difference was significant (P0.01). Conclusion: The two fusion internal fixation methods of the lumbar suspension fixation and the lumbar spinal fixation are effective in the treatment of the degenerative diseases of the lumbar intervertebral disc, and the effect is comparable. The two methods have different degree of image adjacent segment dedifferentiation after the operation, in which the adjacent segment of the suspended fixation group is more prone to image regression, but the symptoms of the lower limb radicular pain caused by the demotion after the operation are more commonly seen in the fixed group of the waist part. The pre-operative pelvic angle of incidence is greater than that of the lumbar lordosis, and it is easier for the post-operative to take place adjacent to the segment.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
，
本文編號：2330804
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