PLIF与MIS-TLIF手术治疗老年患者腰椎退行性疾病疗效分析

发布时间：2018-03-19 14:45

本文选题：老年　切入点：腰椎退行性疾病　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:据世界人口统计学显示,2015年,年龄大于65岁的老年人群人口数量可达6亿,2020年预计突破7亿,全球人口呈现老龄化转变。年龄和病理状态会降低脊柱后纵韧带弹性蛋白含量、躯干、腰背肌肌肉力量及脊柱骨密度,可引起纤维环破裂、髓核脱出、椎间隙高度丢失、黄韧带增生肥厚,小关节增生等腰椎退变,增加腰椎退行性疾病的发病率,导致下肢与躯干部功能障碍,影响患者的生活质量。目前,治疗腰椎退行性疾病的手术方案呈现多样化。其中,腰椎椎间融合术可以有效缓解疼痛并恢复脊柱的生理序列,提高稳定性,缩短患者卧床天数,被认为是治疗腰椎退行性疾病的有效术式。近年来,外科技术的发展呈现微创化与智能化,在脊柱外科领域,微创技术得到迅猛发展,新技术层出不穷,适应范围逐渐扩大,微创椎间融合术MIS-TLIF术式发展迅猛。虽然老年人群有其特殊性,合并基础疾病数量多,平均身体素质差,传统观点认为老年人行脊柱手术所伴发的围手术期风险较高,但也有学者提出大于大于70岁或80岁的老年患者行椎间融合术效果可观,手术安全性较高。本文旨在通过比较75岁以上腰椎退行性疾病患者行PLIF与MIS-TLIF的手术疗效,以对日后高龄群体患者行手术治疗提供临床指导意见。目的:探讨传统开放后路腰椎椎间融合术(posterior lumbar interbody fusion,PLIF)与Quadrant扩张通道辅助的微创经椎间孔入路腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗75岁以上患单节段腰椎退行性疾病(包括腰椎间盘突出症、腰椎管狭窄症、腰椎滑脱症等)的老年患者的临床疗效。方法:回顾性研究2013年1月至2016年1月于本院同一医疗组行单节段腰椎椎间融合内固定术且符合条件的48例患者,其中男性患者29例,女性患者19例,包括腰椎间盘突出症19例,腰椎管狭窄症21例,II度以内腰椎滑脱8例,所有患者年龄均大于75岁,平均年龄为76.9岁,平均病程为64.7个月。结合临床症状、体格检查及腰椎正侧位、腰椎过伸过屈位X线、腰椎CT和腰椎MRI等影像检查。其中26例患者行PLIF手术,余22例行经Quadrant通道下的MIS-TLIF手术。比较两组患者的年龄、性别、病程、手术节段、基础疾病的数目、术前腰腿痛VAS评分、腰椎JOA评分,差异无统计学意义(P0.05)。对PLIF组与MIS-TLIF组的临床疗效(腰腿痛VAS评分及腰椎JOA评分)、术中出血量、术后引流量、卧床天数、住院日等围手术期相关指标与并发症发生率等方面进行对比,分析两种术式对于老年患者群体的临床疗效。结果:MIS-TLIF组与传统PLIF组患者的术后腰腿痛VAS评分与腰椎JOA评分与术前的差异有统计学意义(P0.05);术后3d和3个月的腰腿痛VAS评分MIS-TLIF组较低(P0.05);术后随访1年,两组患者腰腿痛VAS评分及腰椎JOA评分无统计学差异(P0.05);与传统PLIF组相比,MIS-TLIF组的术中出血量、术后引流量、卧床天数、住院日等均有改善(P0.05),但手术时间也更长(P0.05)。MIS-TLIF组术后并发症2例(9.1%),PLIF组6例(23.1%),组间无统计学差异(P0.05),组间术后融合率也无统计学差异(P0.05)。结论:MIS-TLIF与PLIF手术对75岁以上老年患者的临床疗效值得肯定,均能明显改善患者症状,且两种术式能取得相同的临床疗效;MIS-TLIF术式围手术期出血量较少、术后卧床天数及住院日缩短、短期腰背疼痛较轻,对老年患者有创伤小、恢复快等优势。
[Abstract]:Objective: according to the statistics in 2015, the world's population, age older than 65 year old population number is 600 million, 2020 is expected to exceed 700 million, the global population aging presents change. Age and pathological conditions will reduce the longitudinal ligament elastin, posterior trunk, back muscle muscle strength and bone density, can cause fiber ring rupture of nucleus pulposus, loss of intervertebral height, yellow ligament hypertrophy, hyperplasia of lumbar facet joint degeneration, increase the incidence of lumbar degenerative disease rate, resulting in lower limb and trunk dysfunction, affecting the quality of life of the patients. At present, surgical treatment of lumbar degenerative disease. The diversification of the lumbar interbody fusion can effectively relieve pain and restore the spinal physiological sequence, improve stability, shorten the patients bed days, is considered to be effective for the treatment of lumbar degenerative disease in recent years. To show the development of surgical techniques, minimally invasive and intelligent, in spinal surgery, minimally invasive technique has been the rapid development of new technology emerge in an endless stream, gradually expanding the scope of adaptation, interbody fusion MIS-TLIF surgery is minimally invasive. Although the rapid development of the elderly population has its particularity, the average number of underlying diseases, poor physical quality, traditional view elderly patients undergoing spinal surgery are associated with a higher risk of peri operative period, but also some scholars proposed greater than 70 years or 80 year old elderly patients with lumbar fusion effect is considerable, the operation safety is high. The purpose of this paper is in surgery by comparing the above 75 years old of lumbar degenerative disease were treated with PLIF and MIS-TLIF, to provide clinical guidelines for the age group of patients with surgical treatment day. Objective: To explore the traditional open posterior lumbar interbody fusion (posterior lumbar interbody fusion, PLIF and Quadrant) The expansion channel assisted minimally invasive transforaminal lumbar interbody fusion (minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF) in patients over 75 years of suffering from lumbar degenerative diseases (including lumbar disc herniation, lumbar spinal stenosis, lumbar slipping disease) clinical efficacy in elderly patients. Methods: a retrospective review study from January 2013 to January 2016 in our hospital with a medical group for 48 cases of single segmental lumbar interbody fusion and internal fixation and meet the conditions of the patients, including 29 cases of male patients, 19 female patients, including 19 cases of lumbar disc herniation, 21 cases of lumbar spinal stenosis, II degrees of lumbar spondylolisthesis in 8 cases, all the age of the patients was 75 years, the average age is 76.9, the average duration of 64.7 months. According to the clinical symptoms, physical examination and lumbar vertebrae, lumbar radiographs, lumbar CT and lumbar spine MRI examinations. In 26 patients who underwent PLIF surgery, more than 22 cases by Quadrant channel under MIS-TLIF operation. The two groups were comparable in age, gender, disease duration, surgical segment, the number of basic diseases, preoperative leg pain VAS score, lumbar JOA score, the difference was not statistically significant (P0.05). The clinical curative effect of PLIF group group MIS-TLIF (low back pain VAS score and lumbar JOA score), intraoperative bleeding, postoperative drainage, hospitalization days and bed days, around the relevant indicators and perioperative incidence were compared, analysis of two operative methods for the clinical efficacy of community elderly patients. Results: there was significant difference in waist and leg the pain VAS score and lumbar JOA score and preoperative patients in the MIS-TLIF group and the traditional group PLIF after operation (P0.05); low back pain VAS score after operation in MIS-TLIF group and 3 months in 3D low (P0.05); after 1 years follow-up, two patients of lumbar and leg pain VAS score and lumbar JOA score Statistical difference (P0.05); compared with PLIF group, MIS-TLIF group of intraoperative bleeding, postoperative drainage, bed days, hospitalization days were improved (P0.05), but the operation time is longer (P0.05) in 2 cases of postoperative complications of group.MIS-TLIF (9.1%), PLIF group of 6 cases (23.1%). There was no significant difference between groups (P0.05 group), postoperative fusion rate had no significant difference (P0.05). Conclusion: the clinical efficacy of MIS-TLIF and PLIF surgery for elderly patients over 75 years of age should be affirmed, can significantly improve the symptoms of patients, and two kinds of operation can achieve the same clinical efficacy; MIS-TLIF operation perioperative less bleeding, postoperative bed days and hospitalization days, short-term pain is light, for elderly patients with small trauma, quick recovery and other advantages.

【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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