腰椎髓核摘除单侧与双侧CAGE治疗腰椎间盘突出疗效对比

发布时间：2018-03-13 16:27

本文选题：腰椎间盘突出髓核摘除术　切入点：单侧Cage　出处：《延安大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的对比单侧与双侧CAGE在腰椎间盘突出髓核摘除术中的临床应用效果与安全性。方法1.按照连续入组的方式选择需手术治疗的腰椎间盘突出患者100例,按照入院病历尾号奇偶数分为观察组与对照组,每组50例。2.两组患者均采用腰椎后路减压植骨融合内固定术,观察组采用单侧Cage术式,对照组采用双侧Cage术式。3.两组患者术后每月进行电话随访一次,询问患者自我感觉,根据患者对术后自身恢复情况确定来院检查时间,无特殊情况发生者,均要求患者术后1、3、6、12、18个月来院接受检查。4.观察指标:①比较两组患者平均手术时间、术中出血量、术后卧床时间、住院时间及治疗费用;②根据疼痛视觉模拟评分法(the efficacy was assessed using visual analog scores,VAS)[14],比较两组患者术前、术后VAS评分及术后VAS评分优良率;③根据汉化Oswestry功能障碍指数评价表(Oswestry disability index,ODI)评估两组患者术前、术后ODI评分情况,比较ODI评分优良率和ODI评分;④两组患者术后1、3、6、12、18个月拍摄腰椎正侧位及过伸过屈动力位X线片,测量术后椎间隙高度,与术前进行比较;⑤通过CT扫描确定两组患者术后6个月、12个月Cage融合度。⑥比较两组患者术后并发症发生率。5.所得数据应用医学统计软件SPSS19.0进行分析,计量资料用均数±标准差(X±S)表示,组间采用t检验,多时点重复观测资料采用单因素重复测量方差分析;计数资料应用χ2检验,P0.05表示有统计学意义。结果1.观察组患者较对照组平均手术时间短、术中出血量少、术后卧床时间短、住院费用低,比较差异有统计学意义(P0.05)。2.观察组患者术后1个月VAS评分、ODI评分低于对照组,两组比较差异均有统计学意义(P0.05),术后3、6、12、18个月两组患者VAS评分、ODI评分无统计学意义(P0.05),观察组患者术后1个月VAS评分、ODI评分优良率为87.23%。高于对照组的76.09%,比较差异有统计学意义(P0.05)。3.两组患者术后1、3、6、12个月两组患者椎间隙高度依次减低,但术后6个月后椎间隙稳定,术后12、18个月与术后6个月比较椎间隙高度差异无统计学意义(P0.05);两组患者术后1、3、6、12、18个月椎间隙高度比较差异无统计学意义(P0.05)。4.观察组患者术后6个月椎体融合率为82.98%,低于对照组的93.48%,比较差异有统计学意义(P0.05),观察组术后12个月椎体融合率为97.87%,低于对照组的100%,但比较差异无统计学意义(P0.05)。5.两组患者术后均无并发症发生。结论1.单侧Cage治疗椎间盘突出手术创伤小,有助于早期康复,减少治疗费用。2.单侧Cage治疗椎间盘突出术后早期疼痛轻,远期疼痛改善可取得双侧Cage效果。3.单侧Cage治疗椎间盘突出术后早期腰椎生理功能改善优于双侧Cage,远期腰椎生理功能改善与双侧Cage无异。4.单侧Cage治疗椎间盘突出在改善椎间隙方面,可取的双侧Cage的临床效果。5.单侧Cage治疗椎间盘突出术后6个月椎体融合率略低于双侧Cage,但远期融合率无异。6.单侧Cage治疗椎间盘突出安全性较高。
[Abstract]:Objective to compare the unilateral and bilateral CAGE in lumbar discectomy and the clinical effect and safety of surgery. 100 cases of disc herniation patients need surgical treatment according to the selection method of 1. consecutive group means of lumbar, according to the medical records of the tail number of odd number is divided into observation group and control group, each group of 50 cases of.2. two groups of patients were treated with posterior lumbar interbody fusion surgery, observation group were treated with unilateral Cage surgery, the control group with bilateral Cage surgery.3. two group patients were followed up once a month, ask the patient feels, according to the patients for postoperative recovery to the hospital to check to determine its time, no special to happen, all patients 1,3,6,12,18 months after surgery to the hospital for examination of.4. outcome measures: the two groups were compared with the average operative time, intraoperative blood loss, postoperative bed time, hospitalization time and treatment cost; according to the pain The pain visual analogue scale (the efficacy was assessed using visual analog scores, VAS [14]), two groups of the patients were compared before and after operation VAS score and postoperative VAS score excellent rate; according to the Chinese Oswestry disability index evaluation scale (Oswestry disability index, ODI) assessment of two groups of patients before surgery, ODI score after comparison, the good rate of ODI score and ODI score; the two groups of patients after 1,3,6,12,18 months of shooting lumbar vertebrae and dynamic flexion extension radiographs, measuring the height of intervertebral space, compared with the preoperative; through CT scan identified 6 months after operation in the two groups, 12 Cage degree of integration. The comparison of two groups of patients with postoperative complication rate of.5. data from the application of medical statistical software SPSS19.0 analysis, standard deviation measurement data (X + S) said, t test were used for observation, repeated data using single factor weight Analysis of variance of repeated measurement; counting data using 2 test, P0.05 indicated statistical significance. Results of the 1. patients in the observation group compared with the control group, the average operation time is short, less bleeding, postoperative bed time is short, the cost was low, the difference was statistically significant (P0.05).2. observation group of patients after 1 VAS score, ODI score lower than the control group, with significant differences between the two groups (P0.05), 3,6,12,18 months after operation in two groups of patients with VAS score, ODI score was not statistically significant (P0.05), the observation group of patients after 1 months VAS score, 76.09% 87.23%. higher than the control group in the ODI score excellent rate, the difference was statistically significant (P0.05.3.) two groups of patients after 1,3,6,12 months of two groups of patients with intervertebral height decreased, but after 6 months after the intervertebral stability, postoperative 6 months 12,18 months and postoperative intervertebral height difference was statistically significant (P0.05); two No significant group of patients after 1,3,6,12,18 months of intervertebral height difference (P0.05) of.4. patients in the observation group after 6 months of vertebral fusion rate was 82.98%, lower than 93.48% in the control group, the difference was statistically significant (P0.05), the observation group after 12 months of vertebral fusion rate was 97.87%, 100% lower than the control group, but the difference was not statistically significant (P0.05.5.) two groups of patients without postoperative complications. Conclusion 1. unilateral Cage treatment of lumbar disc herniation surgical trauma, is helpful in the early rehabilitation, reduce the cost of treatment of unilateral.2. Cage treatment of intervertebral disc protrusion in early postoperative pain, long-term pain improvement can be achieved in bilateral the effect of Cage.3. Cage in the treatment of unilateral lumbar disc herniation postoperative lumbar physiological function was better than that of bilateral Cage, the lumbar physiological function and improve the bilateral Cage as.4. unilateral Cage treatment of lumbar disc herniation in improving intervertebral space, can be The clinical effect of bilateral Cage was.5.. The fusion rate of vertebral body was slightly lower than that of bilateral Cage at 6 months after unilateral Cage treatment, but the long-term fusion rate was different..6. unilateral Cage treatment had higher safety of intervertebral disc protrusion.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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