恢复椎间隙高度对腰椎滑脱症手术疗效的影响

发布时间：2018-03-06 13:49

本文选题：椎弓根钉系统　切入点：后路椎间融合术　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:针对腰椎滑脱症患者采用椎弓根钉固定全板减压椎间融合术式,通过对比术中撑开椎间隙高度提拉复位与不撑开只提拉复位两种复位固定融合术的术后临床效果,观察恢复椎间隙生理高度的临床效果。方法:选取2012年1月-2016年1月期间一组60例L5椎体前滑脱症(L5/S1间隙滑脱)患者为研究对象,所有患者均经X线片、MRI和腰椎CT检查确诊,全部病例均行椎弓根钉固定+全椎板减压+Cage椎间融合术治疗。按照术中是否行撑开复位(恢复椎间隙高度)操作,病例被分为撑开组(A组)与单纯提拉组(B组)2组,每组各30例。其中,撑开组行椎弓根钉系统提拉+撑开复位+后路减压椎间融合术治疗,其椎间融合器均选取的为威高公司12mm高度椎间融合器融合;单纯提拉组行RF椎弓根钉系统单纯提拉复位+后路减压椎间融合术治疗,术中并不做椎间撑开处理,其椎间融合器均为威高公司8mm高度椎间融合器融合。分别记录两组患者一般资料及术前术后1个月及末次随访的VAS\JOA\ODI评分,以及术后滑脱的矫正程度及骨融合情况,采用Macnab评分临床疗效,制表对比统计学分析。结果:术后1个月及末次随访提示,撑开组较单纯提拉组在椎间隙高度、椎间隙高度/椎体高度比、椎间孔高度、椎间隙角度及临床疗效评分方面均占优势(P0.05)。结论:应用椎弓根钉固定加后路全椎板减压椎间融合术治疗腰椎滑脱症,术中尽可能恢复正常椎体间隙高度,有助于恢复更优的脊柱序列,对于改善患者症状具有一定优势,且术中操作不增加难度,可达到更好的术后效果,推荐临床首选。
[Abstract]:Objective: to compare the postoperative clinical effect of two kinds of reduction and fixation fusion of lumbar spondylolisthesis patients with lumbar spondylolisthesis by pedicle nail fixation with total plate decompression and interbody fusion. Methods: from January 2012 to January 2016, a group of 60 patients with L5 / S1 space spondylolisthesis from January 2012 to January 2016 were selected as the study subjects. All the patients were confirmed by X-ray MRI and lumbar CT examination. All cases were treated with pedicle screw fixation total laminar decompression and Cage intervertebral fusion. According to the operation of distraction reduction (restoring the height of intervertebral space), the patients were divided into two groups: open group (group A) and simple Czochralski group (group B). There were 30 cases in each group. In the open group, the pedicle screw system was used to treat the posterior decompression interbody fusion. The fusion of interbody fusion cage with 12mm height was selected for the interbody fusion cage of Weigao Company. The RF pedicle screw system was used to treat the posterior decompression and intervertebral fusion in the simple traction group, and the intervertebral distraction was not performed during the operation. The interbody fusion cages were all 8 mm height fusion cage of Vigo Company. The general data of the two groups and the VAS\ JOA\ ODI scores of 1 month and the last follow-up before and after operation were recorded, as well as the degree of correction and bone fusion of the postoperative slippage. Results: 1 month and the last follow-up showed that the height of intervertebral space, the ratio of height of intervertebral space to height of vertebral body, the height of intervertebral foramen, the ratio of height of intervertebral space to height of vertebral body, the ratio of height of intervertebral space to height of vertebral body, and the height of intervertebral foramen in the open group were higher than those in the. Conclusion: pedicle screw fixation and posterior total laminar decompression and intervertebral fusion were used to treat lumbar spondylolisthesis, and the normal height of vertebral space was restored as much as possible during the operation. It is helpful to restore a better spinal sequence, has certain advantages to improve the symptoms of patients, and does not increase the difficulty of operation during operation, and can achieve better postoperative results. The first choice of clinical practice is recommended.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】