单、双侧椎弓根螺钉固定治疗双节段腰椎间盘突出症伴退变性腰椎不稳临床疗效比较

发布时间：2018-05-11 01:42

本文选题：单侧椎弓根螺钉内固定 + 椎间融合　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：比较单侧和双侧椎弓根螺钉固定联合患侧腰椎板切除椎管扩大减压椎间cage植骨融合术治疗双节段腰椎间盘突出症伴退变性腰椎不稳的临床疗效,评估单侧椎弓根螺钉内固定优势和可行性。方法：回顾性分析自2012年6月-2015年2月我科收治的36例资料完整的双节段腰椎间盘突出症伴退变性腰椎不稳患者,其中A组18例采用单侧椎弓根固定,B组18例采用双侧椎弓根固定,所有病例均行患侧椎板切除,椎管扩大减压,神经松解及椎间cage融合术。记录A组、B组的手术时间、术中出血、术后引流量及住院时间,并根据JOA(日本骨科协会)评分和VAS(视觉模拟量表)评分全面评估研究对象手术前后腰部症状以及下肢麻痛程度,并根据所获得分估算术后改善率,随访期间行腰椎正侧位片,末次随访时均行腰椎平扫+双能CT,观察植骨融合情况,计算椎间植骨融合率,随访时间为7-32个月,平均为19.5个月。结果：研究结果表明,A组中手术时间、术中出血量、术后引流量均少于B组,差异具有统计学意义(P0.05)；在住院时间方面,两组差异无统计学意义(P0.05)；在并发症方面,单边组发现1例螺帽松动,余均未发现螺钉松动、断裂、cage滑脱、移位或下沉,两组比较无统计学上的差异；在JOA评分及VAS评分方面,两组术前术后比较差异均具有统计学意义(P0.05)。结论：单侧、双侧椎弓根螺钉内固定联合椎间cage融合治疗双节段腰椎间盘突出症伴退变性腰椎不稳近期疗效肯定,均能使腰椎获得可靠的稳定,临床症状改善明显,椎间融合率均高,但前者在手术时间、术中出血量、术后引流量方面占优,并且手术相对简单、术区周围组织损伤相对小,可减少术后相关并发症。
[Abstract]:Objective: to compare the clinical effects of unilateral and bilateral pedicle screw fixation combined with laminectomy and extended decompression with cage bone grafting and fusion in the treatment of double segment lumbar disc herniation with degenerative lumbar instability. To evaluate the advantages and feasibility of unilateral pedicle screw fixation. Methods: from June 2012 to February 2015, 36 patients with double-segment lumbar disc herniation with degenerative lumbar vertebrae instability were retrospectively analyzed. 18 cases of group A were treated with unilateral pedicle fixation and 18 cases of group B were treated with bilateral pedicle fixation. All the patients were treated with ipsilateral laminectomy, enlarged decompression of spinal canal, neurolysis and intervertebral cage fusion. The time of operation, intraoperative bleeding, postoperative drainage and hospitalization time were recorded in group A and group B. The waist symptoms and anaesthesia degree of lower limbs were evaluated according to JOA( Japan Orthopaedic Association) score and VAS (Visual Analog scale) score. According to the score obtained, the rate of improvement was estimated. During the follow-up period, the anterior and lateral lumbar films were performed, and at the last follow-up, the dual energy CT scan of the lumbar vertebrae was performed. The fusion of bone graft was observed, and the fusion rate of intervertebral graft was calculated. The follow-up time was 7-32 months, with an average of 19.5 months. Results: the results showed that the time of operation, the amount of intraoperative bleeding and postoperative drainage in group A were less than those in group B, and the difference was statistically significant (P 0.05), but there was no significant difference in the length of hospitalization between the two groups (P 0.05). There was no significant difference in JOA score and VAS score between the two groups in terms of JOA score and VAS score. Conclusion: unilateral and bilateral pedicle screw internal fixation combined with intervertebral cage fusion in the treatment of two-level lumbar disc herniation with degenerative lumbar instability has positive short-term curative effect, which can make the lumbar vertebrae obtain reliable stability, and the clinical symptoms are improved obviously. The rate of intervertebral fusion was high, but the former was superior in operation time, intraoperative blood loss and postoperative drainage, and the operation was relatively simple, and the injury of surrounding tissues was relatively small, which could reduce the postoperative complications.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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