K-rod非融合手术与MED治疗单节段腰椎间盘突出症的疗效对比分析

发布时间：2018-04-25 12:12

  本文选题：腰椎间盘突出症 + K-rod系统　； 参考：《吉林大学》2017年硕士论文

【摘要】：研究设计:回顾性队列研究目的:对比分析腰椎后路开窗减压髓核摘除K-rod非融合内固定术与显微内窥镜下腰椎间盘切除术(Microendoscopic Discectomy,MED)治疗L4/5单一节段腰椎间盘突出症的临床疗效。方法:回顾分析2010年12月~2013年07月收治的L4/5单节段腰椎间盘突出症患者34例,其中采用K-rod动态稳定系统18例(K-rod组),显微内窥镜腰椎间盘切除术16例(MED组),采用功能障碍指数(Oswestry disability index,ODI)、视觉模拟评分(Visual analogue scale,VAS)及日本骨科协会评估治疗分数(Japanese Orthopedic Association,JOA)作为患者疼痛及功能的评价指标;影像学通过PACS系统测量腰椎侧位X线中手术节段及上、下邻近节段椎间隙变化值,间接评价其退变状况,通过3.0T MRI对手术节段及邻近节段椎间盘进行Pfirrmann分级,直接评价其退变状况。平均随访时间31个月(18~46个月)。结果:末次随访时,两组患者的疼痛及功能指标(ODI、VAS及JOA评分)均较术前有显著改善(P0.05),两组间无显著差异(P0.05)。手术节段及上位邻近节段椎间隙高度K-rod组较术前增高,MED组较术前降低,两组间有显著差异(P0.05),下位邻近节段椎间隙高度组间无显著性差异(P0.05)。两组患者Pfirrmann分级的变化显示,术后末次随访时K-rod组和MED组邻近节段椎间盘均发生不同程度的退变,两组间手术节段及上位邻近节段Pfirrmann分级有显著差异(P0.05),下位邻近节段Pfirrmann分级组间无显著差异(P0.05)。结论:腰椎后路开窗减压髓核摘除K-rod非融合内固定术或显微内窥镜腰椎间盘切除术(MED)治疗单节段腰椎间盘突出症均可取得满意临床疗效,前者在预防手术节段及邻近节段退变等方面更有优势。
[Abstract]:Study Design: retrospective cohort study objective: to compare and analyze the clinical effects of posterior decompression and decompression of nucleus pulposus with K-rod nonfusion internal fixation and microendoscopic discectomy with microendoscopic discectomy MED in the treatment of L4 / 5 single segment lumbar disc herniation (L4 / 5). Methods: Thirty-four patients with L4 / 5 single segment lumbar disc herniation from December 2010 to July 2013 were retrospectively analyzed. Among them, 18 cases were treated with K-rod dynamic stabilization system, 16 cases with microendoscopic lumbar discectomy, and 16 cases with meds. The patients were treated with Oswestry disability index, visual analogue score (visual analogue scale) and Japanese Orthopedic association (JOAA). To evaluate the pain and function of patients. PACS system was used to measure the changes of the intervertebral space between the upper and lower adjacent segments of the lumbar vertebrae, and to evaluate the degeneration status indirectly. The operative and adjacent intervertebral discs were graded with Pfirrmann by 3.0T MRI. The degenerative condition is evaluated directly. The mean follow-up time was 31 months (18 ~ 46 months). Results: at the last follow-up, the pain and function indexes of the two groups were significantly improved as compared with those before operation (P 0.05), and there was no significant difference between the two groups (P 0.05). The height of intervertebral space in K-rod group was significantly lower than that in preoperative group. There was a significant difference between the two groups (P 0.05), but there was no significant difference between the two groups (P 0.05). The changes of Pfirrmann grade in both groups showed that the adjacent intervertebral disc degeneration occurred in K-rod group and MED group at the last follow-up. There was significant difference between the two groups in the Pfirrmann grading of the operative segment and the superior adjacent segment, but there was no significant difference between the lower adjacent segment Pfirrmann grading group and the inferior adjacent segment Pfirrmann classification group. Conclusion: the treatment of single segment lumbar disc herniation by posterior fenestration and decompression of nucleus pulposus with K-rod or microendoscopic discectomy is satisfactory. The former has more advantages in preventing the degeneration of surgical segment and adjacent segment.
【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

【相似文献】

中国硕士学位论文全文数据库 前1条

1 程猛;K-rod非融合手术与MED治疗单节段腰椎间盘突出症的疗效对比分析[D];吉林大学;2017年

，

本文编号：1801259