微创通道下单侧入路双侧减压治疗腰椎双侧侧隐窝狭窄症的疗效研究

发布时间：2018-02-24 14:33

本文关键词： 腰椎1 微创2 椎管减压术3　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨经通道下单侧入路双侧减压、椎间融合、经皮椎弓根钉内固定术相较于传统腰椎后路双侧经椎间孔椎间融合、椎弓根钉内固定术治疗单节段退行性腰椎双侧侧隐窝狭窄症合并椎间不稳的优势。方法:回顾性分析2014年9月至2016年9月在山西大医院骨科行手术治疗的75名单节段退行性腰椎双侧侧隐窝狭窄症合并有腰椎不稳的患者,其中微创组患者35名,采用经通道单侧入路双侧减压、椎间融合、经皮椎弓根钉内固定术;开放组患者40名,采用传统腰椎后路双侧经椎间孔椎间融合、椎弓根钉内固定术。分别记录75名患者术中出血量、术后住院时间及手术时间;记录70名患者手术前及手术后1周、3个月、6个月腰痛视觉模拟评分(VAS),术前及术后3个月、6个月日本骨科协会评分(JOA)和Oswestry功能障碍指数(ODI),两组患者对比评价手术效果。结果:所有患者采取微信平台、电话等方式均获得6个月随访。微创组患者手术时间为(134.3±8.7)ml,开放组患者手术时间为(134.9±8.9)ml,两组对比差异无统计学意义(P0.05);微创组术中出血量为(108.7±13.6)ml,开放组术中出血量为(336.3±30.0)ml,两组对比差异具有统计学意义(P0.05);术后住院时间微创组和开放组分别为(7.8±1.0)天、(14.1±1.3)天,两组对比差异具有统计学意义(P0.05)。手术前两组患者腰椎JOA评分、腰痛VAS评分和ODI指数差异无统计学意义(P0.05),组内比较两组患者术后各时间段腰椎JOA评分与术前相比具有明显提高(P0.05),术后各时间段腰痛VAS评分与术前相比具有明显降低(P0.05);术后第1周及第3个月微创组患者腰痛VAS评分均优于开放组(P0.05),术后第6个月末次随访两组腰痛VAS评分相比差异无统计学意义(P0.05);术后第3个月微创组腰椎JOA评分和ODI评分高于开放组(P0.05),术后第6个月末次随访微创组腰椎JOA评分和ODI评分与开放组相比差异无统计学意义(P0.05)。结论:微创通道下单侧入路双侧减压、椎间融合、经皮椎弓根钉内固定术在治疗退行性双侧腰椎管侧隐窝狭窄症合并椎间不稳上可以获得与传统腰椎后路双侧经椎间孔椎间融合、椎弓根钉内固定术相同的近期手术疗效,且手术创伤小,住院时间短,特别是促进患者早期康复方面具有明显优势。
[Abstract]:Objective: to investigate the bilateral decompression, intervertebral fusion and percutaneous pedicle screw fixation through the unilateral approach under the passage, compared with the traditional posterior lumbar intervertebral fusion. The advantages of pedicle screw internal fixation in the treatment of unilateral degenerative bilateral lumbar recess stenosis with intervertebral instability were analyzed retrospectively from September 2014 to September 2016 in the orthopedic department of Shanxi Provincial Hospital. Patients with bilateral recess stenosis associated with lumbar vertebrae instability, In the minimally invasive group, 35 patients were treated with bilateral decompression, intervertebral fusion and percutaneous pedicle screw fixation, while 40 patients in the open group were treated with traditional posterior lumbar intervertebral fusion. Intraoperative blood loss, postoperative hospital stay and operative time were recorded in 75 patients. Visual analogue scores of low back pain were recorded in 70 patients before operation and 1 week, 3 months and 6 months after surgery. The preoperative and postoperative scores of Japanese Orthopedic Association (JOAA) and the Oswestry dysfunction index were compared between the two groups. Results: all patients took the WeChat platform, The operation time was 134.3 卤8.7 ml in the minimally invasive group and 134.9 卤8.9 ml in the open group. There was no significant difference between the two groups (P 0.05), the intraoperative bleeding in the minimally invasive group was 108.7 卤13.6 ml, and the intraoperative bleeding volume in the open group was 336.3 卤30.0ml. The postoperative hospital stay in the minimally invasive group and the open group were 7.8 卤1.0 days and 14.1 卤1.3 days, respectively. The difference between the two groups was statistically significant (P 0.05). The JOA score of lumbar vertebrae in the two groups before operation was significantly higher than that in the control group. There was no significant difference in VAS score and ODI index of low back pain (P 0.05). The JOA score of lumbar vertebrae in the two groups was significantly higher than that before operation, and the VAS score of low back pain was significantly lower than that before operation. The VAS score of low back pain in the first week and the third month in the minimally invasive group was better than that in the open group. There was no significant difference in the VAS score of lumbar pain between the two groups at the sixth month after operation, and the JOA score of the lumbar vertebrae in the minimally invasive group at the third month after operation was higher than that in the open group. The scores and ODI scores of lumbar spine were higher in the open group than in the open group (P 0.05). There was no significant difference in the JOA score and ODI score of lumbar vertebrae between the minimally invasive group and the open group at the 6th month after operation. Conclusion: bilateral decompression via unilateral approach under minimally invasive channels is not significantly different from that in the open group. Intervertebral fusion and percutaneous pedicle screw fixation can be used to treat bilateral lumbar spinal canal stenosis with intervertebral instability. The internal fixation of pedicle screw had the same short-term curative effect, and the surgical trauma was small and the hospital stay was short, especially in promoting the early recovery of the patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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