脊柱内镜治疗腰椎间盘突出性脊柱侧凸

发布时间：2018-05-13 09:25

本文选题：坐骨神经性脊柱侧凸 + 躯干偏斜　；参考：《山西医科大学》2017年硕士论文

【摘要】：背景:一些腰椎间盘突出的患者不仅存在腰部或腿部的疼痛,同时还存在腰部向侧方的偏斜。对于这些患者,他们不仅关注疼痛的缓解,更关心侧凸的情况什么时候可以纠正。当疼痛通过保守治疗不能得到缓解时,手术治疗具有良好的治疗效果,侧凸会得到有效的纠正。经皮脊柱内镜是一种有效摘除突出髓核的手术方法,但是文献中却鲜有报道治疗脊柱侧凸的治疗效果。目的:探讨腰椎间盘突出与姿势性脊柱侧凸间的关系,总结经皮脊柱内镜治疗存在腰椎间盘突出性脊柱侧凸患者的治疗效果及意义。方法:采用回顾性研究的方法,选取自2016年1月至2016年8月,中国人民解放军总医院单个医生收治的腰椎间盘突出性脊柱侧凸患者47名,其中33名男性,14例女性,年龄在11-57岁之间,平均33.38岁。所有患者均存在严重的腿部疼痛及脊柱侧凸症状,神经支配区域麻木患者29例,9例伴有肌力下降,所有患者经过1个月以上保守治疗无效或存在剧烈急性期疼痛,且未接受过手术治疗。47名患者均接受脊柱内镜腰椎间盘突出髓核摘除术治疗。观察患者在术前、术后3个月、6个月及终末随访时视觉模拟评分(Visual Analogue Scale,VAS)评价腰部及腿部疼痛程度。于术前及末次随访时通过Oswestry功能障碍指数(Oswestry disability index,ODI)及日本骨科协会评估治疗分数(Japanese Orthopaedic Association Scores,JOA)评估患者腰痛功能障碍的情况。通过测量术前及末次随访腰椎Cobb角评价患者侧凸改善情况。结果:本组47名患者均得到随访,随访时间为6-14个月,平均11个月。其中1名患者因术后下肢肌力减弱不缓解,行开放手术;2名患者出现其他节段再次突出,未行手术治疗。其余44名患者腰椎间盘突出临床症状均明显改善。腰痛VAS从术前(5.91±1.36)分别降至术后3个月(3.93±0.84),术后6个月(2.72±1.14),末次随访(2.11±1.31),组间具有统计学差异(F=95.04,P0.001)。腿痛VAS从术前(7.70±0.98)分别降至术后3个月(2.23±1.22),术后6个月(1.81±1.33),末次随访(1.38±1.47)。组间具有统计学差异(F=260.19,P0.001)。ODI从术前(68.51±11.75)下降至末次随访(11.82±10.12)(Z=-6.71,P0.001);JOA从术前(8.72±1.64)改善至至末次随访(24.47±3.01)(t=-37.22,P0.001),术后临床改善率为(77.87±14.10)%。术前腰椎Cobb角平均为(12.98±5.92)°,术后末次随访腰椎Cobb角平均为(3.81±3.22)°(Z=-5.72,P0.001)。其中10名患者完全纠正,23名患者明显改善;13名患者改善,1名患者无明显变化。按照Macnab评分标准:优30例,良11例,可6例,差1例,总体优良率为87.2%。结论:脊柱内镜技术具有创伤小、出血少、恢复快等临床特点可以通过较小的手术切口解除患者的临床症状,其中70.2%的患者的脊柱侧凸症状得到纠正,对于腰椎间盘突出性脊柱侧凸患者具有较好的治疗效果。脊柱侧凸的方向与腰椎间盘突出的位置及有症状侧的方向是存在着一定的关联性,即74.4%的脊柱侧凸患者会偏向健侧,而70.2%的突出物位于侧凸凸侧的方向。
[Abstract]:Background: some patients with protrusion of the lumbar intervertebral disc not only have pain in the waist or leg, but also the skewness to the side of the waist. For these patients, they not only pay attention to the pain relief, but also care about when the situation of scoliosis can be corrected. When the pain is not relieved through conservative treatment, the surgical treatment has good treatment. The treatment effect, scoliosis will be effectively corrected. Percutaneous endoscopic spinal endoscopy is an effective method to remove the nucleus of the protruding pulp, but there are few reports on the treatment of scoliosis in the literature. Objective: To explore the relationship between protrusion of the lumbar intervertebral disc and postural scoliosis, and to sum up the protrusion of the lumbar intervertebral disc by percutaneous endoscopic Spina endoscopic treatment. Treatment effect and significance of scoliosis patients. Methods: a retrospective study was used to select 47 patients with lumbar disc herniation from January 2016 to August 2016, including 33 men and 14 women with an average age of 11-57 years, with an average of 33.38 years of age. All patients were saved. In severe leg pain and scoliosis symptoms, 29 patients were numbness in the innervation area, 9 were accompanied by a decrease of muscle strength. All patients were ineffective or had acute acute stage pain after 1 months of conservative treatment, and no surgical treatment of.47 patients received endoscopic lumbar disc herniation for treatment. Preoperative, 3 months, 6 months, and final follow-up (Visual Analogue Scale, VAS) were used to evaluate the degree of pain in the waist and leg. The Oswestry dysfunction index (Oswestry disability index, ODI) and the Department of orthopedics Association of Japan were used to evaluate the treatment score (Japanese Orthopaedic Association) before and after the follow-up. OA) evaluation of patients with low back pain dysfunction. Results: 47 patients in this group were followed up with an average of 6-14 months, an average of 11 months, and 1 of them were open to lower limb muscle strength after operation, and 2 patients appeared other segments. The clinical symptoms of lumbar disc herniation in the rest of the 44 patients were obviously improved. Low back pain VAS was decreased from preoperative (5.91 + 1.36) to 3 months (3.93 + 0.84), 6 months (2.72 + 1.14) after operation, and last follow-up (2.11 + 1.31). The group had statistical difference (F=95.04, P0.001). The VAS of leg pain decreased from before operation (7.70 + 0.98). 3 months after operation (2.23 + 1.22), 6 months (1.81 + 1.33) and last follow-up (1.38 + 1.47). There were statistical differences (F=260.19, P0.001).ODI from preoperative (68.51 + 11.75) to last follow-up (11.82 + 10.12) (Z=-6.71, P0.001), JOA from preoperative (8.72 +) to final follow-up (t=-37.22, P0.001), and postoperative clinical changes The good rate was (77.87 + 14.10)% (77.87 + 14.10). The average lumbar Cobb angle was (12.98 + 5.92) degrees (3.81 + 3.22) degrees (3.81 + 3.22) degrees after the last follow-up. 10 patients were completely corrected, 23 patients improved obviously; 13 patients improved and 1 patients were changed. According to the Macnab score standard: 30, 11, 6, 1, and so on. The overall good rate is 87.2%. conclusion: spinal endoscopy has small trauma, less bleeding and rapid recovery. The clinical features can be relieved by a smaller operative incision, of which 70.2% of the patients have a correction of scoliosis and a better therapeutic effect for the patients with protrusion of the lumbar intervertebral disc scoliosis. There is a certain correlation between the direction of the lumbar intervertebral disc herniation and the direction of the symptomatic side, that is, 74.4% of scoliosis patients tend to the healthy side, and 70.2% of the protruding is located in the direction of the scoliosis side.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】