两种术式治疗退行性腰椎失稳滑脱疗效对比

发布时间：2018-05-08 18:21

本文选题：退变性腰椎滑脱 + 微创TLIF　；参考：《新乡医学院》2017年硕士论文

【摘要】：目的两种手术方式治疗退行性腰椎失稳滑脱的对比分析。方法回访收集分析2014年1月1日至2014年12月31日期间新乡医学院第一附属医院骨外科收住院的老年性轻度腰椎滑脱患者56例,分别采用微创TLIF和开放TLIF手术方式,微创TLIF的手术方法,即在Quadrant系统引导下,直视进行圆锥、神经根及椎管减压,不稳定椎体植骨融合,椎弓根螺钉三柱内固定。微创TLIF手术患者26例,开放后路TLIF手术患者30例。分别按照术中切口长度(cm)、手术时间(min)、术中及术后出血量(ml)、总住院天数(d)等数据来统计;通过视觉模拟评分的方法和JOA下腰痛评分系统,将手术前症状,分别对比患者术后症状的改善程度,周期分为三天、两周、三月、半年、一年,加以统计分析;观察患者术前术后1周、半年、1年所测量的椎体滑脱角、滑脱率的纠正情况,椎间隙高度的撑开恢复情况,术后随访拍摄术后半年、1年CT及X线片通过同一副主任医师影像学评估椎体间固定植骨融合率。结果微创TLIF组中,26例患者全部获得术后半年随访,4例患者在术后1年失访;而在开放手术组中,有5例患者失去随访,失访率16%;随访时间跨度为6-30个月,平均19个月。对比分析两组术后伤口长度,总体出血量,住院总天数,微创组较开放组少,统计学存在差异,本次研究手术均由熟练的高年资医师操作,手术耗时总体相比开放手术组短,但P0.05,统计学差异不明显。通过术后症状分析,患者的VAS、JOA评分、ODI均反映出症状减轻,手术效果良好,统计学计算存在显著性差异(P0.05)。同样的,通过术后3月症状分析,患者的VAS、JOA评分、ODI均反映出症状明显减轻,手术效果良好,统计学计算存在显著性差异(P0.05)。术后影像学检查数据显示两组腰椎滑脱角、椎间隙高度、滑脱率均较术前有明显纠正,术前术后存在明显统计学差异,而两组间对比无统计学差异。影像学分析微创手术组在术后6月的融合率(Suk标准)达到88.5%,术后6个月融合率微创TLIF组23例(88.5%),开放TLIF组14例(46.7%),两组1年后的融合率微创TLIF组20例(76.9%)(注:术后1年,微创TLIF组26例患者中失访4例),5例可能融合;开放TLIF组23例(76.7%)(注:术后1年,开放TLIF组30例患者中失访5例),3例可能融合;尽管相比开放组,微创组术后6个月显示出了更高的融合率,但并无明显统计学差异,P0.05。结论微创TLIF手术方式和开放TLIF手术方式相比较,减少了手术出血量,住院时间缩短,术后恢复较快,减少了术后慢性腰痛及腰椎术后综合征的发生,滑脱的纠正,椎间高度的恢复及融合率与开放术式区别不大。因此,对于老年退变行椎管狭窄及滑脱失稳,微创TLIF技术是有效的治疗手段。
[Abstract]:Objective to compare the two surgical methods in the treatment of degenerative spondylolisthesis. Methods from January 1, 2014 to December 31, 2014, 56 cases of senile mild lumbar spondylolisthesis in the first affiliated Hospital of Xinxiang Medical College were collected and analyzed. The patients were treated with minimally invasive TLIF and open TLIF respectively. Under the guidance of Quadrant system, minimally invasive TLIF was performed with conical decompression, nerve root and spinal canal decompression, unstable bone graft fusion and pedicle screw fixation. There were 26 cases of minimally invasive TLIF operation and 30 cases of open posterior TLIF operation. According to the length of incision, the time of operation, the amount of blood lost during and after operation, the total days of hospitalization, and so on, the symptoms before operation were evaluated by visual analogue scoring method and low back pain scoring system under JOA. The period was divided into three days, two weeks, three months, six months, one year, to make statistical analysis, to observe the correction of spondylolisthesis angle and rate of spondylolisthesis measured 1 week, half a year and one year before and after operation. The height of intervertebral space was opened and recovered. The fusion rate of interbody fixation was evaluated by CT and X ray radiographs at 1 year after follow up half a year after operation by the same assistant chief physician. Results in the minimally invasive TLIF group, all the 26 patients were followed up half a year after operation and 4 patients lost their visit at 1 year after operation, while in the open operation group, 5 patients lost the follow-up and the lost visit rate was 16. The follow-up time ranged from 6 to 30 months, with an average of 19 months. The length of wound, the amount of blood loss, the total length of hospitalization, the number of patients in the minimally invasive group were less than those in the open group, and there were statistical differences between the two groups. The operation in this study was performed by a skilled senior physician, and the total duration of the operation was shorter than that in the open operation group. But P0.05, the statistical difference is not obvious. Through the analysis of postoperative symptoms, the patients' VAS-JOA score and ODI all reflected the relief of symptoms, and the effect of operation was good. There was significant difference in statistical calculation (P 0.05). Similarly, through the symptom analysis of 3 months after operation, the patients' VASV JOA score and ODI showed that the symptoms were obviously relieved and the operation effect was good. There was a significant difference in statistical calculation between the two groups (P 0.05). The postoperative imaging data showed that the lumbar spondylolisthesis angle, height of intervertebral space and the rate of spondylolisthesis were significantly corrected in the two groups, and there was significant statistical difference between the two groups before and after operation, but there was no statistical difference between the two groups. The fusion rate was 88.5in the minimally invasive operation group (6 months after operation), in the minimally invasive TLIF group (23 cases) at 6 months after operation, in the open TLIF group (14 cases) and in the open TLIF group (46.7%). The fusion rate of the two groups after one year in the minimally invasive TLIF group (20 cases) was 76.9cm (note: 1 year after operation). Of the 26 patients in the minimally invasive TLIF group, 4 had lost access and 5 were likely to be fused, while in the open TLIF group, there were 23 cases with 76. 710% of the 30 patients in the open TLIF group, 5 of the 30 patients in the open TLIF group were likely to be fused, although compared with the open group, 3 cases were likely to be fused. In the minimally invasive group, a higher fusion rate was found 6 months after operation, but there was no significant difference between the two groups (P 0.05). Conclusion compared with open TLIF, minimally invasive TLIF can reduce the amount of bleeding, shorten the hospital stay, recover quickly after operation, reduce the incidence of postoperative chronic low back pain and lumbar spondylolumbar syndrome, and correct spondylolisthesis. The recovery and fusion rate of intervertebral height was not different from that of open operation. Therefore, minimally invasive TLIF is an effective treatment for degenerative spinal canal stenosis and slippage instability.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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