胸腰段椎管狭窄症患者手术疗效与影响因素分析

发布时间：2018-03-18 12:50

本文选题：胸腰段椎管狭窄　切入点：脊髓功能损伤　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性的研究27例胸腰段(T10-L2)椎管狭窄症手术患者,评估其手术疗效及术后神经功能的影响因素。方法:回顾性分析吉林大学中日联谊医院2013年1月到2016年9月中27例胸腰段椎管窄患者的临床数据。采用JOA脊髓损害评分表(29分法)及美国ASIA分级评估术前、术后一周时及末次随访时脊髓功能。计算术后JOA恢复率评估手术疗效,记录术后是否有神经症状加重及其影响因素,对相关因素进行多因素logistic回归分析,并观察有无脑脊液漏等并发症。结果:接受胸腰段后路减压减压植骨融合内固定术患者27例,男性10例,女性17例,其中后路环形减压植骨融合内固定术15例,全椎板切除植骨融合内固定12例。年龄(18-82)岁,加重组平均年龄(55.29±20.806)岁,非加重组(53.50±11.283)岁;术前自然病程(2—120个月),加重组平均(28.14±28.485个月),非加重组平均(24.50±28.112)个月;术前JOA评分加重组平均(5.57±1.512)分,非加重组平均(10.25±2.552)分,术后随访时间6-36个月,平均18.37个月。术后JOA评分改善率优良的有19例(70.37%),一般的有4例(14.81%),无变化的有4例(14.81%)。其中7例患者于术后出现脊髓功能损伤加重,6例经对症及康复治疗后,于术后2周-3个月开始恢复,1例于末次随访时(18个月)仍无明显恢复。经多因素logistic回归分析后提示在手术时间、出血量、术前JOA评分等相关因素中,术前JOA评分的对于患者出现术后脊髓损伤功能加重有统计学意义。结论:手术治疗是胸腰段椎管狭窄的有效治疗方式,虽有一定术后脊髓功能损伤加重的风险。但经激素冲击、脱水及康复治疗后,患者的脊髓功能大部分能得到恢复。早期的诊断及手术治疗以及患者术前的JOA评分对胸腰段椎管狭窄症的治疗和远期预后起到重要的作用。术前JOA评分与患者术后的症状加重相关。
[Abstract]:Objective: to retrospectively study 27 patients with thoracolumbar segment T10-L2 spinal stenosis. Methods: the clinical data of 27 patients with thoracolumbar spinal canal stenosis from January 2013 to September 2016 were analyzed retrospectively. Spinal cord injury was performed with JOA. The damage score scale (29 scores) and the ASIA grading of the United States were evaluated before operation. Spinal cord function was evaluated at the first week after operation and at the last follow-up. The recovery rate of postoperative JOA was calculated to evaluate the outcome of the operation, and the neurological symptoms and its influencing factors were recorded. The related factors were analyzed by multivariate logistic regression analysis. Results: 27 patients (10 males and 17 females) underwent posterior thoracolumbar decompression, bone grafting and internal fixation. Total laminectomy and bone graft fusion and internal fixation were performed in 12 cases. The average age was 55.29 卤20.806 years (n = 18), and 53.50 卤11.283 years (n = 10) in the non-aggravation group, and the natural course of the disease was 2-120 months before operation, with an average of 28.14 卤28.485 months plus recombination and an average of 24.50 卤28.112 months without recombination. The mean score of JOA score plus recombination was 5.57 卤1.512, and the average score of non-recombination was 10.25 卤2.552. The follow-up time was 6-36 months. The average time was 18.37 months. The improvement rate of JOA score was good in 19 cases (70.37), normal in 4 cases (14.81%) and unchanged in 4 cases (14.81%). From 2 weeks to 3 months after operation, 1 case had no significant recovery at the last follow-up (18 months). Multivariate logistic regression analysis showed that the time of operation, blood loss, preoperative JOA score, and other related factors were related factors, such as operation time, blood loss, preoperative JOA score, and so on. Conclusion: surgical treatment is an effective treatment for thoracolumbar spinal canal stenosis, although there is a certain risk of postoperative spinal cord injury. After dehydration and rehabilitation, Early diagnosis and surgical treatment as well as preoperative JOA score play an important role in the treatment and long-term prognosis of thoracolumbar spinal stenosis. The exacerbation of symptoms after the event is related.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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