PLIF治疗腰椎间盘突出症术后复发的临床疗效

发布时间：2018-03-03 04:29

本文选题：腰椎间盘突出症复发　切入点：临床疗效　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的评价使用腰椎后路减压椎间融合术治疗腰椎间盘突出症术后复发患者的临床疗效。方法2007年1月—2012年6月间上海交通大学附属第六人民医院收治的56例腰椎间盘突出症术后复发患者。根据复发患者的主要临床症状,将56岁患者分为腰腿痛组(9例)、下肢麻木伴放射感组(18例)和腰腿痛伴下肢麻木组(26例)。再次手术方式为腰椎后路减压椎间融合术。分别于术前和术后3、6、12、24个月采用腰椎JOA评分评估患者术后的腰椎功能改善情况,采用疼痛VAS评分评估腰痛和腿痛的程度。术后24个月随访时,患者根据自身情况,采用改良的Mac Nab疗效评定标准对手术疗效进行评价。术前和术后24个月使用腰椎功能障碍指数评估术前以及术后终末随访腰椎功能障碍恢复情况。结果3种临床分组患者术后3、6、12、24个月的JOA评分均显著高于同种临床分组术前JOA评分(P值均0.05)。随访24个月时,腰腿痛组患者的JOA评分改善率显著高于下肢麻木伴放射感组和腰腿痛伴下肢麻木组(P值均0.05),腰腿痛伴下肢麻木组患者的JOA评分改善率显著高于下肢麻木伴放射感组(P值0.05)。3种临床分组患者术后3、6、12和24个月的腿痛VAS评分均显著低于同种临床分组术前(P值均0.05),腰腿痛组和腰腿痛伴下肢麻木组患者术后3、6、12、24个月的腰痛VAS评分均显著低于同种临床分组术前(P值均0.05);下肢麻木伴放射感组患者术后3个月的腰痛VAS评分显著高于同种临床分组术前(P值0.05),术后12和24个月的腰痛VAS评分均显著低于同种临床分组术前(P值均0.05)。术后24个月时,根据改良的Mac Nab疗效评定标准,腰腿痛组患者治疗满意率为100%,下肢麻木伴放射感组患者治疗满意率为88.89%,腰腿痛伴下肢麻木组患者治疗满意率为93.10%。3种临床分组患者术后24个月腰椎功能障碍指数显著低于同种临床分组术前腰椎功能障碍指数(P值均0.05)。结论腰椎后路减压椎间融合内固定术治疗腰腿痛组和腰腿痛伴下肢麻木组腰椎间盘突出症术后复发患者疗效较佳,而治疗下肢麻木伴放射感组患者疗效尚可。
[Abstract]:Objective to evaluate the clinical effect of posterior lumbar decompression and interbody fusion in the treatment of recurrent lumbar disc herniation. Methods from January 2007 to June 2012, 56 cases of lumbar vertebrae were treated in 6th people's Hospital affiliated to Shanghai Jiaotong University. Patients with recurrent disc herniation after operation. According to the main clinical symptoms of recurrent patients, The patients aged 56 years were divided into low back pain group (n = 9), lower extremity numbness with radiosensory group (n = 18) and low back leg pain with lower limb numbness group (n = 26). Posterior lumbar decompression interbody fusion was performed again. JOA score was used to evaluate the improvement of lumbar function after operation. The severity of low back pain and leg pain was evaluated with pain VAS score. The modified Mac Nab evaluation criteria were used to evaluate the outcome of the operation. The lumbar spine dysfunction index was used before and 24 months after operation to evaluate the recovery of lumbar spine dysfunction. The JOA scores were significantly higher than those of the preoperative JOA scores (P < 0.05) at 12 and 24 months postoperatively, and were significantly higher than those in the same clinical groups at 24 months follow-up. The improvement rate of JOA score in patients with lumbago and leg pain was significantly higher than that in patients with lower extremity numbness and radiosensory and low back and leg pain with lower limb numbness (P = 0.05). The improvement rate of JOA score in patients with low back pain and lower limb numbness was significantly higher than that in patients with lower extremity numbness and radiosensory. The VAS scores of leg pain were significantly lower at 12 and 24 months after operation in patients with low back pain and low back leg pain with lower limb numbness than those in patients with low back pain and lower extremity numbness. The VAS scores of low back pain group and low back leg pain with lower limb numbness group were significantly lower than those of the same clinical group before operation (P < 0. 05). The VAS score of low back pain at 24 months was significantly higher in patients with low back pain and leg pain with lower limb numbness. The VAS score of patients with lower limb numbness and radiosensitivity was significantly higher than that of patients with low back pain (P = 0.05) at 3 months after operation, and the VAS score of low back pain at 12 and 24 months after operation was significantly lower than that in patients with lower extremity numbness and radiosensitivity. The preoperative P values of allogeneic groups were 0.05 and 24 months after operation, According to the modified Mac Nab criteria, The satisfaction rate was 100 in the low back and leg pain group, 88.89 in the lower limb numbness with radiosensitivity group and 93.10.3 in the low back leg pain with lower limb numbness group. Conclusion posterior lumbar decompression and interbody fusion and internal fixation are effective in the treatment of lumbar intervertebral disc herniation in patients with low back leg pain and lower extremity numbness. The treatment of lower limb numbness combined with radiosensory group was effective.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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