经椎间孔单侧入路双侧减压融合内固定治疗腰椎管狭窄症

发布时间：2018-01-19 02:23

本文关键词： 腰椎管狭窄症单侧入路双侧减压椎间融合内固定椎旁肌　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的比较经椎间孔单侧入路双侧减压和双侧棘突旁小切口入路双侧减压并行椎间融合内固定术治疗腰椎管狭窄症的近期临床疗效,以评估经椎间孔单侧入路双侧减压术的临床价值。方法自2014年7月至2015年6月,将48例需要进行减压融合内固定的腰椎管狭窄症患者随机分为单侧入路双侧减压组(24例)和双侧小切口入路双侧减压组(24例),单侧入路双侧减压组:男10例,女14例,年龄48～82岁,平均65.6岁。双侧小切口入路双侧减压组:男12例,女12例,年龄48～72岁,平均60.4岁。分别对两组患者的.围手术期基本情况、手术相关情况、手术并发症发生率、椎间融合率进行对比分析。测定术前及术后第1、3、7天肌酸激酶水平。所有患者获得随访,对术前及术后3、6、12个月进行视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数评分。结果比较两组病例,手术时间、术中出血量、住院天数、椎间融合率、并发症发生率差异无统计学意义(P0.05),但单侧入路双侧减压组术后第1天肌酸激酶水平、术后引流量、术后腰背痛VAS与双侧小切口入路双侧减压组比较差异存在统计学意义(P0.05)。两组病例随访时间12-24个月,平均17个月,单侧入路双侧减压组腰背痛VAS由术前平均(7.1±0.8)分降至术后12月平均(1.5±0.5)分,Oswestry功能障碍评分由术前平均(36.3±1.1)分降至术后12月平均(2.8±0.8)分,提示手术效果优良。结论经椎间孔单侧入路双侧减压或双侧棘突旁小切口双侧减压并行椎间融合内固定术治疗腰椎管狭窄症均取得良好的临床疗效,但是单侧入路双侧减压椎间融合内固定术式具有手术创伤小、避免双侧肌肉剥离、对椎旁肌的损伤小,能极大保留脊柱后方结构,术后引流量少、恢复快、住院时间短、短期疗效确切等优点。
[Abstract]:Objective to compare the short-term clinical effects of bilateral decompression via intervertebral foramen approach and bilateral spinous process approach combined with interbody fusion and internal fixation in the treatment of lumbar spinal stenosis. To evaluate the clinical value of bilateral decompression via unilateral intervertebral foramen approach. Methods from July 2014 to June 2015. Forty-eight patients with lumbar spinal stenosis who needed decompression fusion and internal fixation were randomly divided into unilateral and bilateral decompression group (n = 24) and bilateral decompression group (n = 24). Bilateral decompression group with unilateral approach: male 10, female 14, age 48 ~ 82 years, mean 65.6 years. Bilateral decompression group: male 12, female 12, age 48 ~ 72 years. The average age of 60.4 years was 60.4 years. The basic condition of perioperative period, operation related condition, the incidence of complications and the rate of intervertebral fusion were compared and analyzed respectively. The first trimester was measured before and after operation. 7 days creatine kinase level. All patients were followed up. Visual analogue scale was evaluated by visual analogue score before and after 3 months and 12 months. Results the operative time, intraoperative bleeding volume, hospital stay and intervertebral fusion rate were compared between the two groups. There was no significant difference in the incidence of complications (P 0.05), but the level of creatine kinase and the drainage volume were found on the 1st day after operation in the unilateral and bilateral decompression group. The difference between VAS and bilateral decompression group was statistically significant (P 0.05). The follow-up time of the two groups was 12-24 months (mean 17 months). The VAS score of bilateral decompression group decreased from 7. 1 卤0. 8 before operation to 1. 5 卤0. 5 on December. The score of Oswestry dysfunction decreased from 36.3 卤1.1 to 2.8 卤0.8 in December. Conclusion bilateral decompression or bilateral spinous process small incision combined with intervertebral fusion and internal fixation are effective in the treatment of lumbar spinal stenosis. But unilateral approach and bilateral decompression interbody fusion and internal fixation have less surgical trauma, avoid bilateral muscle stripping, less injury to the paravertebral muscle, can greatly preserve the posterior structure of the spine, less drainage and faster recovery. The hospital stay is short, the short-term curative effect is definite and so on.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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