单侧TLIF治疗外侧、极外侧腰椎间盘突出症的临床研究

发布时间：2018-04-18 23:03

本文选题：单侧 + TLIF　；参考：《青海大学》2015年硕士论文

【摘要】：目的:研究单侧TLIF对外侧、极外侧腰椎间盘突出症手术治疗的效果,分析单侧TLIF手术的优势与不足。方法:选取青海大学附属医院脊柱外科2011年3月至2014年3月期间手术治疗的外侧、极外侧腰椎间盘突出症患者30例;手术前进行随机分组,每一组各15例。单侧TLIF组采取单侧TLIF手术治疗,PLIF组采取PLIF手术治疗,所有30例手术都由同一组医师完成。术前给予止痛、对症治疗,充分卧床休息,积极进行保守治疗。术前进行VAS评分、JOA评分。术后抗感染、脱水、止血等对症支持治疗。根据预案对两组术中指标(详见表2,表3)进行统计。术后3个月随访进行VAS评分、JOA评分,随访3月、6月、1年腰椎正侧位片,评价椎间融合情况,记录开始融合的时间。结果:与PLIF组的患者相比,单侧TLIF组手术时间更短,手术出血也更少,对比差别具有统计学意义。卧床时间、切口长度、椎体间融合率、开始融合时间两组进行比较,差别无统计学意义(P0.05)。采用单侧TLIF手术治疗的患者手术时间116.5±13.2min、术中出血量247.3±46.8ml、手术切口7.09±0.1cm、卧床时间4.4±0.83d;开始融合时间3.8±1.12 month,融合率80.00%。PLIF组手术时间180.0±20.9min、术中出血量454.6±56.9ml、手术切口长度7.12±0.2cm、卧床时间4.6±0.81,椎体间融合时间4.0±1.36month,融合率86.67%。术后3月统计疗效,单侧TLIF组和PLIF组的疗效分别为80.0%和73.3%,比较差别无统计学意义(P0.05)。单侧TLIF组VAS评分术前7.71±0.62分,术后2.30±0.84分,改善率(70.63±8.6)%,JOA评分术前11.86±2.1分,术后20.80±3.5分,改善率(75.2±8.6)%。PLIF组VAS术前8.26±0.56分、术后2.41±0.71分,改善率(71.31±8.1)%,JOA术前11.93±1.8分,术后20.86±3.5分,改善率(74.8±9.6)%。单侧TLIF与PLIF组手术前VAS、JOA评分和术后3月随访的评分对比其差别均无统计学意义((P0.05);结论:单侧TLIF和PLIF手术相比较,其手术出血少,手术时间短,是一种治疗外侧、极外侧腰椎间盘突出症更加安全、可靠的术式。
[Abstract]:Objective: to study the effect of unilateral TLIF on lateral and extreme lateral lumbar disc herniation and to analyze the advantages and disadvantages of unilateral TLIF.Methods: thirty patients with lateral and far lateral lumbar disc herniation were selected from spinal surgery department of Qinghai University affiliated Hospital from March 2011 to March 2014.Unilateral TLIF group was treated with unilateral TLIF operation. All 30 cases of PLIF operation were performed by the same group of physicians.Preoperative pain relief, symptomatic treatment, full bed rest, active conservative treatment.VAS score and JOA score were performed before operation.Postoperative anti-infection, dehydration, hemostasis and other symptomatic support treatment.Two groups of intraoperative indexes (see Table 2 and Table 3 for details) were counted according to the plan.The VAS score was followed up for 3 months. The anterior and lateral lumbar vertebrae were followed up for 3 months, 6 months and 1 year to evaluate the intervertebral fusion and to record the time when fusion began.Results: compared with PLIF group, unilateral TLIF group had shorter operation time and less bleeding.The time of bed rest, length of incision, fusion rate between vertebrae and fusion time between the two groups were compared. There was no significant difference between the two groups (P 0.05).The operation time of unilateral TLIF was 116.5 卤13.2 minutes, the intraoperative bleeding was 247.3 卤46.8 ml, the incision was 7.09 卤0.1 cm, the bed-rest time was 4.4 卤0.83 days, the fusion time was 3.8 卤1.12 monthth.The fusion rate was 180.0 卤20.9 min, the intraoperative bleeding was 454.6 卤56.9 ml, the incision length was 7.12 卤0.2 cm, the bed-rest time was 4.6 卤0.81, and the vertebrae fusion time was 3.8 卤1.12month.The operative incision length was 7.12 卤0.2cm, and the bed-rest time was 4.6 卤0.81in the 80.00%.PLIF group.The interbody fusion time was 4.0 卤1.36 month.The fusion rate was 86.67.Three months after operation, the curative effect of unilateral TLIF group and PLIF group were 80.0% and 73.3%, respectively. There was no significant difference between the two groups (P 0.05).The VAS score of unilateral TLIF group was 7.71 卤0.62 before operation, 2.30 卤0.84 after operation. The improvement rate was 11.86 卤2.1 before operation and 20.80 卤3.5 after operation. The improvement rate was 8.26 卤0.56 before VAS and 2.41 卤0.71 in 8.6)%.PLIF. The improvement rate was 11.93 卤1.8 before operation and 20.86 卤3.5 after operation. The improvement rate was 74.8 卤9.6B.There was no significant difference between unilateral TLIF and PLIF before operation and 3 months follow-up. Conclusion: compared with PLIF, unilateral TLIF has less bleeding and shorter operation time, so it is a kind of lateral treatment.Far-lateral lumbar disc herniation is safer and more reliable.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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