髓核摘除Cosmic单侧非融合动态固定与单侧融合椎弓根钉内固定治疗腰突症的对照研究

发布时间：2018-03-06 07:34

  本文选题：腰椎间盘突出症　切入点：动态内固定　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：一、研究目的回顾性研究Cosmic单侧非融合动态内固定和单侧融合内固定两种方法治疗腰椎间盘突出症的临床疗效。二、研究方法从2010年1月至2012年9月,对36例腰椎间盘突出症(L5S1)患者分别采用髓核摘除Cosmic单侧非融合内固定(18例)和髓核摘除单侧融合内固定(18例)进行手术治疗;非融合组18例,男8例,女10例,年龄40-59岁,平均49岁;融合组18例,男11例,女7例,年龄37-60岁,平均48.5岁。所有患者术前均行腰椎正侧位及过伸过屈位X线片、腰椎CT以及腰椎MRI检查。共手术36例,术后进行随访,36例均获得随访,其中Cosmic单侧固定非融合组随访时间为12至25个月,平均随访时间为19.5个月,单侧内固定融合组随访时间为12至26个月,平均随访时间为20.5个月。期间记录两组手术时间,术中出血量;分别评估患者术前及术后末次随访时痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分,并进行统计学分析比较;在腰椎动力位X线片上分别测量并记录患者术前及术后末次随访时手术节段(L5S1)、邻近节段(L4,5)和腰椎(L1S1)的活动度(range of motion,ROM),并进行统计学分析比较。三、研究结果所有患者术后切口I期愈合。两组患者截止至末次随访期间未有神经根损伤、感染、脑脊液漏、椎间盘突出复发、融合器移位及内固定植入物松动断裂等并发症。对手术时间及术中出血量进行统计学分析比较(见表1),非融合组及融合组平均手术时间分别为72±3.1min及98.0±2.9min,术中平均出血量依次分别为131.0±8.0ml及166.0±8.1ml,且两比较项差异均有统计学意义(P0.01),即融合组手术时间及术中出血量均高于非融合组(P0.01)。对两组患者术前术后(末次随访)VAS及ODI评分进行统计学分析比较(见表2),非融合组术前及末次随访VAS评分分别为7.0±1.5分及2.8±1.1分,术前及末次随访ODI评分分别为44.0±5.4分及18.1±5.0分;融合组术前及末次随访VAS评分分别为8.0±1.5分及3.0±1.8分,术前及末次随访ODI评分分别为46.0±6.2分及19.1±4.9分。纵向比较术前及术后末次随访之VAS评分及ODI评分,两组差异均有统计学意义(P0.01),两组患者术后的ODI及VAS评分较术前均有明显改善。横向比较非融合组及融合组组间,相对应时段的VAS评分及ODI评分,差异无统计学意义(P0.05)。即依据VAS评分及ODI评分来评估治疗效果,则两组在腰椎间盘突出症治疗上均有显著效果,而两组间治疗效果则无明显差别。对两组患者术前术后各节段ROM(°)进行统计学分析比较(见表3)。非融合组术前ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分别为5.6±1.6°、8.0±1.2°及21.1±3.8°,术后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分别为5.1±1.0°、7.2±1.1°及21.4±1.9°;融合组术前ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分别为6.2±2.0°、8.0±1.7°及21.2±4.6°,术后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)依次分别为1.5±1.0°、6.3±1.5°及19.6±2.2°。两组手术前后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)差异均无统计学意义(P0.05)。非融合组术后ROM(L5S1)、ROM(L4,5)及ROM(L1S1)与术前差异均无统计学意义(P0.05);融合组术后ROM(L4,5)与术前差异无统计学意义(P0.05),而ROM(L5S1)及ROM(L1S1)与术前差异有统计学意义(P0.05),均较术前减小。四、研究结论两种手术方式在腰椎间盘突出症的治疗上均能取得满意效果。髓核摘除Cosmic单侧非融合内固定与髓核摘除单侧融合内固定相比,所耗手术时间短,出血量较后者少,并且对术后相关节段和腰椎的活动度破坏较轻。
[Abstract]:A research objective to retrospectively study the clinical curative effect of unilateral Cosmic non fusion dynamic fixation and unilateral internal fixation and fusion of two methods in the treatment of lumbar disc herniation. Two research methods from January 2010 to September 2012, 36 cases of lumbar disc herniation (L5S1) were treated with unilateral discectomy Cosmic non fusion internal fixation (18 cases) and unilateral discectomy fusion and internal fixation (18 cases) were treated surgically; non fusion group 18 cases, male 8 cases, female 10 cases, age 40-59 years, average 49 years old; fusion group 18 cases, male 11 cases, female 7 cases, age 37-60 years, average 48.5 years old. Patients underwent preoperative lateral lumbar spine and flexion extension radiographs of lumbar CT and lumbar MRI examination. A total of 36 cases of surgery, postoperative follow-up, 36 cases were followed up, including Cosmic unilateral fixation and non fusion groups were followed up for 12 to 25 months, the average follow-up time was 19.5 months unilateral internal fixation fusion group. Followed up for 12 to 26 months, the average follow-up time was 20.5 months. During the recording of the two groups in operation time, intraoperative blood loss were assessed; scores of pain in patients with preoperative and postoperative follow-up (visual analogue, scale, VAS), Oswestry disability index (Oswestry disability index, ODI) score, and compared; in the lumbar dynamic X-ray films were measured and recorded before and after the surgery at the end of the follow-up operation segment (L5S1), adjacent segment (L4,5) and lumbar (L1S1) activity (range of, motion, ROM), and statistical analysis. Three the results of the study, all patients postoperative incision stage I healing. Two groups of patients during the deadline to the end of the follow-up injury, no nerve root infection, cerebrospinal fluid leakage, recurrent disc herniation, fusion translocation and internal fixation implant loosening and other complications. The operative time and intraoperative bleeding 閲忚繘琛岀粺璁″�﹀垎鏋愭瘮杈�(瑙佽〃1),闈炶瀺鍚堢粍鍙婅瀺鍚堢粍骞冲潎鎵嬫湳鏃堕棿鍒嗗埆涓，

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