高位腰椎间盘突出症的诊疗分析

发布时间：2018-04-21 17:38

本文选题：腰椎退变 + 高位腰椎间盘突出　；参考：《苏州大学》2015年硕士论文

【摘要】：第一部分高位腰椎间盘突出症的手术治疗目的:探讨高位腰椎间盘突出症的临床特点及手术治疗。方法:回顾性分析2009~2013年收治的36例单节段高位腰椎间盘突出症患者的随访资料,应用改良Macnab标准评价临床疗效,采用视觉模拟疼痛评分(VAS)和Oswestry功能障碍指数(ODI)评分标准进行量化及统计学分析,SUK标准评估X线植骨融合,CT植骨融合率按照Annette Kettler报导的方法计算,采用独立样本t检验进行统计学分析。结果:男24例,女12例,年龄37~66岁,平均55.4岁,随访11~43个月,平均24个月。11例L1/2、14例L2/3行TLIF术,11例L2/3行PLIF术。按改良Macnab评价临床疗效:优22例,良8例,可4例,差2例。末次随访平均ODI及VAS评分分别为20.62±4.72、2.02±0.74分,均优于术前评分51.22±4.61、8.33±0.82分,差异具有统计学意义(P0.0001)。PLIF术治疗患者术后VAS及ODI评分较TLIF术患者差,但无统计学意义。PLIF术患者术后6例脑脊液漏,2例持续神经根刺激症状,1例大小便功能障碍,Tl IF术患者无并发症发生。术后末次随访X线及CT评估椎间植骨融合率为100%,术后腰椎前凸角及椎间隙高度较术前均有明显改善。结论:高位腰椎间盘突出症的临床表现复杂,神经损害较重,漏诊率高,一旦确诊,应早期手术解除压迫。高位腰椎间盘突出症PLIF术并发症较多,不宜应用,推荐使用TLIF术。第二部分不同节段高位腰椎间盘突出的对比研究—ODI评分在腰椎疾患治疗中的意义目的:对比分析ODI评分与Prolo评分在高位腰椎间盘突出患者评估中的应用,探讨高位腰椎的范围及ODI评分在腰椎间盘突出患者治疗中的意义。方法:2008-2013年于我院手术治疗的腰椎间盘突出患者中,随机选取24例L1-L2及L2-L3节段突出患者作为A组,24例L3-L4节段突出患者作为B组,记录患者术前及术后一年的Prolo、ODI评分并对比,以ODI的改善(降低百分比)评价神经功能的恢复,并进行统计学分析。结果:A、B两组Prolo评分结果有明显差异。两组患者的术后ODI较术前有显著改善(P0.05)。两组患者之间术后ODI评分及ODI的改善差异明显,有统计学差异(P0.05)。术前较高的ODI评分对手术疗效的影响是负面的,A组患者中,2位(8.3%)患者术后评分升高,而B组患者术后ODI评分均有显著降低。结论:L1-L2及L2-L3节段与L3-L4节段手术疗效差异明显。ODI评分较Prolo评分更关注患者主观症状及功能的改变,对手术疗效有更高的敏感性,建议作为高位节段突出患者的术前评估方法。
[Abstract]:Part I: surgical treatment of high lumbar disc herniation objective: to explore the clinical features and surgical treatment of high lumbar disc herniation. Methods: the follow-up data of 36 patients with single segment high lumbar disc herniation from 2009 to 2013 were analyzed retrospectively. The clinical efficacy was evaluated by modified Macnab criteria. The visual analogue pain score (VASA) and the Oswestry dysfunction index (Oswestry) were used for quantitative and statistical analysis. The fusion rate of X-ray bone graft fusion and CT bone graft fusion was calculated according to the method reported by Annette Kettler. Independent sample t test was used for statistical analysis. Results: 24 males and 12 females, aged 3766 years (mean 55.4 years), were followed up for 11 ~ 43 months, with an average of 24 months. 14 cases of L 2 / 3 with L 2 / 3 were treated with TLIF. 11 cases with L 2 / 3 were treated with PLIF. The clinical efficacy was evaluated by modified Macnab: excellent in 22 cases, good in 8 cases, fair in 4 cases, poor in 2 cases. The mean ODI and VAS scores of the last follow-up were 20.62 卤4.72 卤2.02 卤0.74, respectively, which were better than those of the preoperative scores of 51.22 卤4.61 and 8.33 卤0.82, respectively. The difference was statistically significant (P 0.0001U, P 0.0001A, P < 0.05). The VAS and ODI scores of the patients treated with TLIF were lower than those of the patients with TLIF. However, there was no statistical significance in 6 cases of cerebrospinal fluid leakage and 2 cases of persistent nerve root irritation after PLIF. There was no complication in 1 case of dysphoria and urinal dysfunction. The rate of intervertebral bone graft fusion was 100 in the last follow-up. The lumbar kyphosis angle and the height of intervertebral space were significantly improved after operation. Conclusion: the clinical manifestation of high lumbar disc herniation is complicated, the nerve damage is serious, and the rate of missed diagnosis is high. High lumbar intervertebral disc herniation (PLIF) has many complications and should not be used. TLIF is recommended. The significance of ODI score and Prolo score in the treatment of Lumbar Disc Disc Herniation objective: to compare and analyze the application of ODI score and Prolo score in the evaluation of patients with high lumbar disc herniation. To explore the range of high lumbar vertebrae and the significance of ODI score in the treatment of lumbar disc herniation. Methods from 2008 to 2013, 24 patients with L1-L2 and L2-L3 segment herniation were randomly selected as group A and 24 patients with L3-L4 segment herniation as group B. Prologil ODI scores before and after operation were recorded and compared. The improvement (decrease percentage) of ODI was used to evaluate the recovery of neural function. Results there was significant difference in Prolo score between the two groups. The postoperative ODI in both groups was significantly improved than that before operation (P 0.05). There was significant difference in ODI score and ODI between the two groups (P 0.05). The effect of high preoperative ODI score on the operative efficacy was that the postoperative scores of 2 patients in group A were significantly higher than those in group B, but the ODI scores in group B were significantly lower than those in group A. Conclusion compared with Prolo score, the score of Prolo is more concerned with the changes of subjective symptoms and functions, and has a higher sensitivity to the operative efficacy. It is suggested to be a preoperative evaluation method for the patients with high segmental protrusion.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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