MIS-TILF与PLIF治疗单节段退行性腰椎疾病的护理比较

发布时间：2018-01-21 05:20

本文关键词： 脊柱疾病腰椎外科手术微创性护理　出处：《中国矫形外科杂志》2016年21期 　论文类型：期刊论文

【摘要】：[目的]观察扩张通道管系统(X-tube)辅助微创经椎间孔入路腰椎椎体间融合术(minimally invasive surgery transforaminal lumbar interbody fusion,MIS-TLIF)与传统开放后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗单节段退行性腰椎疾病的相关临床疗效,并比较其护理措施。[方法]回顾性分析2013年12月~2014年12月本院骨科行手术治疗的单节段退行性腰椎病变患者,其中行MIS-TLIF手术的患者48例、行PLIF手术的患者39例,统计术前心理评估指标、术中出血量、术后伤口引流量、术后1d直腿抬高度数、术后卧床时间、术后平均住院天数、腰背痛视觉模拟评分(visual analogue scale,VAS)以及术后康复锻炼的完成情况,并对两组结果进行比较。[结果]手术前HAMA评分、HAMD评分、SAS评分和SDS评分,PLIF组均高于MIS-TLIF组(P0.05);MIS-TLIF组术中出血量、术后伤口引流量、术后卧床时间、术后平均住院天数均比PLIF组明显减少(P0.05),术后1 d直腿抬高度数则明显增加(P0.05),术后第3、5 d及3个月,MIS-TLIF组腰背痛VAS评分明显低于PLIF组(P0.05),术后1 d和3 d,MIS-TLIF组康复锻炼完成率明显高于PLIF组。[结论]MIS-TLIF手术治疗单节段退行性腰椎疾病手术切口小,术前患者的心理负担较小,术后伤口疼痛轻,可提早进行康复锻炼,缩短了平均住院天数,减少并发症的发生,一定程度减轻了护理工作量,在把握好适应证的情况下,值得在有条件开展此类手术的医院进行推广。
[Abstract]:[Objective] to observe the effect of X-tube-assisted minimally invasive lumbar interbody fusion via intervertebral foramen approach. Minimally invasive surgery transforaminal lumbar interbody fusion. MIS-TLIFand traditional open posterior lumbar interbody fusion with posterior lumbar interbody fusion. The clinical efficacy of PLIF in the treatment of single segment degenerative lumbar vertebra disease was compared and the nursing measures were compared. [Methods: from December 2013 to December 2014, 48 patients with single segment lumbar degenerative disease treated by orthopedic surgery in our hospital were analyzed retrospectively. Among them, 48 patients underwent MIS-TLIF operation. In 39 patients undergoing PLIF operation, the preoperative psychological evaluation index, intraoperative bleeding volume, postoperative wound drainage flow, straight-leg elevation degree 1 day after operation, postoperative bed rest time and average postoperative hospital stay were statistically analyzed. The visual analogue score of low back pain (VAS) and the completion of postoperative rehabilitation exercise were compared between the two groups. [Results: before operation, HAMA score and SDS score were higher in HAMA group than in MIS-TLIF group (P 0.05). In MIS-TLIF group, the amount of intraoperative bleeding, postoperative wound drainage, postoperative bed-rest time and average postoperative hospital stay were significantly lower than those in PLIF group (P 0.05). On the 1st day after operation, the degree of straight leg elevation increased significantly (P 0.05), and the 3rd day and the third month after operation. The VAS score of low back pain in MIS-TLIF group was significantly lower than that in PLIF group (P 0.05). The completion rate of rehabilitation exercise in MIS-TLIF group was significantly higher than that in PLIF group on the 1st and 3rd day after operation. [Conclusion: MIS-TLIF operation for single segment degenerative lumbar disease has a small incision, less psychological burden and less postoperative wound pain, so rehabilitation exercise can be carried out early. It can shorten the average hospitalization days, reduce the occurrence of complications and reduce the nursing workload to a certain extent. It is worth popularizing in the hospitals which have the condition to carry out this kind of operation under the condition of grasping the indication.
【作者单位】：解放军总医院骨科专科医院骨二科;
【基金】：解放军总医院临床科研扶持基金(项目编号:2013FC-ISYS-1002)
【分类号】：R473.6
【正文快照】： 传统开放后路腰椎椎间融合术(posterior lumbarinterbody fusion,PLIF)自20世纪40年代成功开展以来,应用十分广泛。近年来,各种各样的微创手术发展迅猛,扩张通道管系统辅助微创经椎间孔入路腰椎椎体间融合术(minimally invasive surgery transforaminallumbar interbody fusio

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