Dynesys系统在治疗腰椎间盘突出症中的创伤应激反应及临床疗效观察

发布时间：2018-05-14 22:42

本文选题：腰椎 + 非融合　；参考：《宁波大学》2015年硕士论文

【摘要】：目的评估Dynesys动态固定系统在腰椎间盘突出症治疗中的急性期组织创伤应激反应及早中期临床疗效。方法2012年12月—20l4年2月采用Dynesys系统治疗单节段腰椎间盘突出患者25例(Dynesys组),同期实施腰椎经椎间孔椎间融合TLIF术的27例单节段腰椎间盘突出症患者作为对照(TLIF组),记录两组手术时间、出血量,术前、术后6小时、12小时、24小时不同时间点患者IL-6、TNF-α,术前及术后1天、2天、5天CRP等血清浓度指标,术前、术后3个月、末次各随访过程中的时间点ODI和VAS评分。对比两组数据差别,评估两组手术急性期组织创伤应激程度及术后疗效情况。结果Dynesys组平均手术时间112.3±20.4min,平均术中出血量232±63ml少于TLIF组的平均手术时间148.8±56.2 min,平均术中出血量405±85ml(P0.05)。对比两组患者术前血清IL-6、TNF-α、CRP炎性指标,无明显差别(P0.05),术后均有上升,其中TLIF组术后IL-6、CRP浓度变化较Dynesys组大,组间差别有统计学意义(P0.05),但两组间TNF-α浓度未见显著差异(P0.05)。与术前相比,两组术后各随访时间点的ODI及VAS评分大幅改善,改善程度具有统计学差别(P0.05),但两组间对比差别不显著(P0.05)。结论Dynesys动态内固定与TLIF融合术均获得良好临床疗效,与TLIF术相比,Dynesys系统手术组织创伤应激反应较小,对于降低术后创伤应激反应,提高手术安全性具有积极意义。
[Abstract]:Objective to evaluate the clinical efficacy of Dynesys dynamic fixation system in the treatment of lumbar disc herniation. Methods from December 2012 to February 2014, 25 patients with single segment lumbar disc herniation were treated with Dynesys system, and 27 patients with single segment lumbar disc herniation were treated by transforaminal lumbar intervertebral fusion TLIF. The operation time of the two groups was recorded. The serum levels of IL-6 TNF- 伪 in patients with IL-6 TNF- 伪 were measured at different time points (preoperative, 6 hours, 12 hours and 24 hours after operation). The serum levels of CRP were measured before and 1 day after operation. The ODI and VAS scores were obtained at the time points of preoperative, 3 months, and the last follow-up. To compare the difference of data between the two groups, and evaluate the degree of tissue trauma stress and the curative effect after operation in the acute stage of operation between the two groups. Results the mean operative time in Dynesys group was 112.3 卤20.4min, and the mean intraoperative blood loss was 232 卤63ml less than that in TLIF group (148.8 卤56.2 mins). The average intraoperative blood loss was 405 卤85ml P0.05min. There was no significant difference in serum levels of IL-6 TNF- 伪 and CRP between the two groups before operation, but there was no significant difference between the two groups (P 0.05), but there was no significant difference in the concentration of TNF- 伪 between the two groups (P 0.05). The level of IL-6 and TNF- 伪 in the TLIF group was larger than that in the Dynesys group after operation, and the difference between the two groups was statistically significant (P0.05), but there was no significant difference in the concentration of TNF- 伪 between the two groups. The ODI and VAS scores of the two groups were significantly improved compared with those before operation, and the degree of improvement was statistically different (P 0.05), but the difference between the two groups was not significant (P 0.05). Conclusion Dynesys dynamic internal fixation and TLIF fusion have good clinical effect. Compared with TLIF system, the traumatic stress response of dynesys system is less, which is of positive significance to reduce the postoperative trauma stress response and improve the safety of operation.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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