K-rod动态稳定系统治疗中青年单节段腰椎间盘突出症术后中期随访研究

发布时间：2018-02-21 07:19

本文关键词： K-rod动态系统腰椎间盘突出症中期随访　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过功能评分及影像学测量评价，研究中青年单节段腰椎间盘突出症患者接受腰椎K-rod动态稳定系统术后中期随访疗效及K-rod系统对腰椎保护作用的分析。方法:选取我院2010年12月～2014年7月，使用K-rod腰椎动态稳定系统治疗的51例中青年单节段腰椎间盘突出症患者，其中男29例，女22例，年龄19～58岁，，平均40.3岁。术后随访1～3年。采用JOA评分及VAS评分对患者术前、术后、中期随访的功能变化进行评价，通过术前、术后及中期随访影像资料测量弹性节段及相邻节段的椎间隙变化值、弹性节段与相邻节段在腰椎动力位上的椎间成角及椎体矢状面滑移值，以及观察术前、术后及中期腰椎MRI终板Modic的改变以评估K-rod系统对腰椎的保护作用。结果： 1、患者术后1个月、6个月、1年、2年、3年JOA评分分别为23.94±1.47、25.00±1.23、25.72±1.92、26.25±1.08、26.20±1.64，相对于术前JOA评分14.83±1.75，均存在显著差异（P㩳0.05）；患者术后1个月、6个月、1年、2年、3年VAS评分分别为2.95±0.28、2.00±0.96、1.63±1.33、1.29±0.95、1.20±1.30，相对于术前VAS评分6.75±0.92，均存在显著差异（P㩳0.05）。 2、术后1个月、术后3个月、6个月、1年、2年、3年弹性节段椎间隙变化值为0.31±1.76、1.18±1.42、0.49±1.63、0.78±1.51、0.14±1.93、0.42±0.83，术后相邻节段对应的椎间隙变化值为-0.03±1.56、-0.04±0.71、-1.11±0.95、0.99±1.47、0.59±0.61、-0.12±1.36。 3、术前、术后3个月、6个月、1年、2年、3年弹性节段在腰椎动力位的椎间成角分别为8.43±3.35、8.65±1.99、9.98±2.45、9.89±3.41、8.95±3.32、9.96±3.21；相邻节段在腰椎动力位上的椎间成角为分别为8.40±3.96、9.43±3.50、9.61±3.62、11.47±3.50、9.62±5.23、10.77±5.91；椎体矢状面滑移值弹性节段分别为1.67±1.42、1.36±0.74、1.67±0.86、1.99±0.83、1.71±0.26、1.21±1.27；相邻节段椎体滑移值分别为1.03±1.00、1.28±0.60、1.48±1.35、1.90±0.60、1.48±1.03、2.42±0.87，术后各期随访结果与术前结果行t检验分析，P值均＞0.05。 4、术前MRI发现6例患者手术节段存在Modic改变，6例俱为Modic1级，术后随访3例，俱达到1年以上，其中1例患者随访达到3年，术后复查腰椎MRI显示手术节段Modic改变明显好转。结论：中期随访研究表明，腰椎K-rod动态稳定系统治疗单节段中青年腰椎间盘突出症，能够有效改善临床症状、维持腰椎稳定性、预防腰椎弹性节段及相邻节段退行性变，且对Modic改变的可逆性变化具有一定的改善作用。
[Abstract]:Objective: to study the effect of K-rod dynamic stabilization system on lumbar spine protection in young and middle-aged patients with single segment lumbar disc herniation by functional score and imaging measurement. Methods: from December 2010 to July 2014, 51 young and middle-aged patients with single segment lumbar disc herniation treated with K-rod lumbar dynamic stabilization system were selected, including 29 males and 22 females, aged 1958 years. The average age was 40.3 years. The patients were followed up for 1 ~ 3 years. The functional changes were evaluated by JOA score and VAS score. The changes of intervertebral space between elastic segment and adjacent segment, intervertebral angle and sagittal slip value of elastic segment and adjacent segment in lumbar dynamic position were measured and observed before operation. Changes of Modic in lumbar MRI endplate were performed to evaluate the protective effect of K-rod system on lumbar spine. Results:. 1. The JOA scores of the patients 1 month, 6 months, 1 year, 2 years and 3 years after operation were 23.94 卤1.477.00 卤1.237.00 卤1.92n 25.72 卤1.92n 26.25 卤1.08 卤26.20 卤1.64, respectively, compared with the preoperative JOA score of 14.83 卤1.75, there were significant differences between the two groups (P < 0.05). The VAS scores of 1 month, 6 months, 1 year, 2 years and 3 years after operation were 2.95 卤0.282.00 卤0.96 卤1.63 卤1.33 卤1.29 卤0.951.20 卤1.30, respectively, compared with the preoperative VAS score of 6.75 卤0.92. 0.05. 2, 1 month, 3 months, 6 months, 1 year, 2 years and 3 years after operation, the change value of the elastic segmental intervertebral space was 0.31 卤1.76 卤1.18 卤1.42 卤1.62 卤0.49 卤1.63U 0.78 卤1.53U 0.14 卤1.93U 0.42 卤0.83, and the corresponding intervertebral space of the adjacent segments was -0.03 卤1.56U -0.04 卤0.71U -1.11 卤0.95U 0.99 卤1.470.59 卤1.470.59 卤0.12 卤1.363respectively. 3, before operation, The intervertebral angle of 3 months, 6 months, 1 year, 2 years and 3 years after operation was 8.43 卤3.35 卤3.35 卤9.65 卤1.99 卤9.98 卤2.45 卤9.89 卤3.41 卤8.95 卤3.32 卤9.96 卤3.21, 8.40 卤3.96 卤3.32 卤3.21, 8.40 卤3.969.43 卤3.50 9.61 卤3.629.61 卤3.629.47 卤5.509.62 卤5.2310.77 卤5.91, respectively, and the sagittal slip value was 1.67 卤1.421.36 卤0.741 卤0.741 卤0.261.21 卤0.261.21 卤1.2771 卤0.261.21 卤1.271.27, respectively, and the intervertebral angle of adjacent segment was 8.40 卤3.96.43 卤3.50 卤3.629.62 卤5.2310.77 卤5.91, respectively. The sagittal slip value was 1.67 卤1.421.36 卤0.761 卤0.261.21 卤1.271.71 卤0.261.21 卤1.271.71 卤0.261.21 卤0.261.21 卤1.271.71 卤0.261.71 卤0.261.21 respectively. The slippage values of adjacent segments were 1.03 卤1.00 ~ 1.28 卤0.60 ~ 1.48 卤1.35 卤1.90 卤0.60 ~ 1.48 卤1.48 卤1.03 卤2.42 卤0.87, respectively. The results of follow-up and preoperative results were all higher than 0.05 (P < 0.05). 4. Preoperative MRI revealed that 6 cases had Modic changes in the surgical segment, 6 cases had Modic1 grade, 3 cases had been followed up for more than 1 year, and 1 case had been followed up for 3 years. The postoperative MRI examination showed that the change of Modic in the surgical segment was obviously improved. Conclusion: the mid-term follow-up study shows that the treatment of single segment lumbar disc herniation with K-rod dynamic stabilization system can effectively improve clinical symptoms, maintain lumbar stability and prevent degeneration of lumbar elastic segment and adjacent segment. And it can improve the reversible change of Modic.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.32

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