单节段固定融合临近节段减压治疗双节段腰椎退变短期疗效分析

发布时间：2018-03-18 08:19

本文选题：临近节段退变(ASD)　切入点：单纯减压　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：目的:调查腰椎临近阶段退变(ASD)发生率及相关危险因素。考虑单节段融合固定临近阶段减压术治疗多节段腰椎退变可行性,评估单节段融合固定临近阶段减压术治疗多节段腰椎退变术后疗效。方法:查阅近年关于腰椎融合术后出现ASD的概念、发生率、相关影响因素和预防等方面的文献,并进行综述。本次研究共调查了115名患者,这些患者均在术前进行了完善的影像学与症状学评估,确诊为多节段腰椎管狭窄,并根据腰椎正侧位、动力位、左右侧屈位、脊柱全长正侧位片,排除患者合并有退行性腰椎后凸,退行性腰椎侧弯,排除患者矢状位失平衡。其中男性患者55名,女性患者60名,平均年龄54.2岁,年龄最长72岁,最小42岁。所有的患者都是因主诉腰痛、下肢麻木或是间歇性跛行,来我院就诊,症状持续时间平均4年,最长15年,最短1年。我根据症状、查体及影像学明确责任间隙,其中责任间隙为L4/5、L5/S1或是L3/4、L4/5。所有的患者并无脊柱手术史,但基本所有患者或多或少都经过保守治疗,并且无明显改善。对115名接受单节段融合固定临近阶段减压手术患者进行为期两年的随访,于术前,术后1年,术后2年查腰椎正侧位,腰椎动力位,术后2年查腰椎CT,临床效果方面,对患者术前,术后3天,术后1年,术后2年随访ODI,VAS评分,对于术后2年腰椎CT及腰椎动力位显示腰椎腰椎融合良好的患者进行统计学评估。结果:术后2年随访,腰椎融合成功患者共114例,ODI评分和VAS评分手术后均有明显逐渐改善。未发现超过4mm的前后滑移或侧方滑移,由关节突增生引起的神经压迫症状,退行性侧弯,超过10%的椎间隙塌陷,超过3mm的骨赘形成。单纯减压节段活动度术后较术前无明显增大,甚至单纯减压节段活动度较术前略有减小。结论:此项研究认为单节段融合固定双节段减压术对于治疗老年双节段腰椎管狭窄的短期疗效是良好的,而相关的理论依据仍需我们进一步研究,包括腰椎矢状位力线,腰椎生物力学,腰椎间盘退变的分子生物学基础。而在选择性融合固定广泛减压手术治疗广泛腰椎退变方面,我认为前景是客观,仍需更多临床、基础研究加以证实。
[Abstract]:Objective: to investigate the incidence and risk factors of ASD in the near stage of lumbar vertebrae. Objective: to evaluate the efficacy of single segment fusion fixation approach decompression in the treatment of multilevel lumbar degenerative degeneration. Methods: recent literature on the concept, incidence, related factors and prevention of ASD after lumbar fusion were reviewed. A total of 115 patients were investigated in this study, all of whom underwent a complete preoperative imaging and symptomatic evaluation, and were diagnosed with multilevel lumbar spinal stenosis according to the lateral position, the dynamic position, the flexion position of the left and right lumbar vertebrae. The full-length anterior-lateral radiography of the spine excluded the patients with degenerative lumbar kyphosis, degenerative lumbar scoliosis and sagittal disequilibrium, including 55 males and 60 females, with an average age of 54.2 years, the longest being 72 years old. The youngest 42 years old. All patients are due to the main complaints of low back pain, lower limb numbness or intermittent claudication, the average duration of symptoms of 4 years, the longest 15 years, the shortest year. The responsibility gap is L 4 / 5 / L 5 / S 1 or L 3 / 4% L 4 / 5. All patients have no history of spinal surgery, but almost all patients are treated more or less conservatively. There was no significant improvement. 115 patients undergoing single-segment fusion fixation were followed up for two years. The anteroposterior and lateral position of lumbar vertebrae and lumbar dynamic position were examined before, 1 year after operation and 2 years after operation. Two years after operation, the clinical effect of lumbar CTS was evaluated. The patients were followed up with ODII VAS before operation, 3 days after operation, 1 year after operation and 2 years after operation. Two years after operation, patients with good lumbar fusion were evaluated by lumbar CT and lumbar dynamic position. Results: two years after operation, all patients were followed up. There was no obvious improvement after operation in 114 patients with successful lumbar fusion. There was no anterior or posterior slippage or lateral slippage more than 4 mm. The symptoms of nerve compression and degenerative scoliosis caused by articular process hyperplasia were not found. More than 10% of the intervertebral spaces collapsed and more than 3 mm of osteophyte were formed. Even simple decompression is slightly less active than that before operation. Conclusion: this study suggests that single-segment fusion fixation and two-level decompression is effective in the short-term treatment of two-level lumbar spinal stenosis in the elderly. The relevant theoretical basis needs further study, including the sagittal force line of lumbar vertebrae, the biomechanics of lumbar vertebrae, the molecular biological basis of lumbar disc degeneration, and the extensive decompression and fixation of selective fusion fixation for the treatment of extensive lumbar degenerative degeneration. I think the prospects are objective and need more clinical, basic research to confirm.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3

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