单侧与双侧TLIF术治疗单节段腰椎退行性疾患的中长期疗效比较

发布时间：2018-05-19 13:47

本文选题：单侧 + 双侧　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:比较单侧与双侧TLIF术治疗单节段腰椎退行性疾病的中长期临床疗效方法:回顾性分析我院2007年3月至2010年3月因单节段腰椎退行性疾病入院患者共171例,依据纳入标准分为腰椎单侧椎弓根螺钉固定结合TLIF术组及双侧椎弓根螺钉固定结合TLIF术组。单侧组患者79例,其中76例获得随访,男37例,女39例,年龄25-65岁,平均45.32岁.双侧组患者92例,其中87例获得随访,男性49例,女性38例,年龄26-70岁,平均50.13岁。所有患者术前均完善腰椎X线、CT及MRI检查,由同一组医师行单侧或双侧椎弓根螺钉固定联合TLIF术,记录手术操作时间、术中伤口出血量、术后伤口引流量及住院天数。采用日本骨科学会(JOA)评分法、疼痛视觉模拟评分(VAS)评估患者术前、术后三月及末次随访疗效及疼痛情况,通过影像学测量手术节段椎间隙高度,并评估末次随访时椎体间融合情况以及分析相关并发症。结果:患者随访时间5-8年,平均6.8年,单侧组与双侧组在手术时间、术中出血量、术后引流量及住院时间有显著差异(P0.05)。JOA及VAS评分单侧组与双侧组比较无显著差异(P0.05),术前与末次随访差异有统计学意义(P0.05).单侧组与双侧组在同一时间点手术前后椎间隙高度差异无统计学意义(P0.05)但末次随访时病变间隙高度与手术前比较有明显差异,且差异具有统计学意义(P0.05)。末次随访融合率单侧组与双侧组无显著差异(P0.05)。未发现椎弓根螺钉松动、脱出、断钉等情况发生。结论:单侧椎弓根螺钉内固定联合TLIF与双侧固定在治疗单节段腰椎退行性疾病中长期临床疗效均满意,单侧TLIF更具有手术时间短、术中出血少、住院时间短等优点,是治疗单阶段腰椎退行性疾病的较好选择,但手术适应症我们应严格掌握。
[Abstract]:Objective: To compare the medium and long term clinical efficacy of unilateral and bilateral TLIF in the treatment of single segment lumbar degenerative disease: a retrospective analysis of 171 patients admitted to the hospital from March 2007 to March 2010 with single segment lumbar degenerative disease was divided into unilateral lumbar pedicle screw fixation combined with TLIF and bilateral pedicle screw according to the inclusion criteria. There were 79 cases in one side group, of which 76 cases were followed up in one side group, including 37 men, 39 women, 25-65 years old and 45.32 years old. There were 92 cases in bilateral group, of which 87 were followed up, 49 men, 38 women, 26-70 years of age and average age. All patients improved the lumbar X ray, CT and MRI examination before operation, and the single side was performed by the same group of doctors. Or bilateral pedicle screw fixation combined with TLIF, the operation time, the amount of bleeding in the operation, the postoperative wound flow rate and the number of days in hospital were recorded. The Japanese Department of orthopedics Society (JOA) scoring method and the pain visual analogue score (VAS) were used to evaluate the effect and pain of the patients before and after the March and last follow-up, and the surgical section was measured by imaging. Intervertebral height, interbody fusion and related complications were evaluated at the last follow-up. Results: patients were followed up for 5-8 years, averaging 6.8 years. There was significant difference between unilateral group and bilateral group at operation time, intraoperative bleeding volume, postoperative flow rate and time of hospitalization (P0.05), there was no significant difference in.JOA and VAS scores between unilateral and bilateral groups (P 0.05) there was significant difference between the preoperative and the last follow-up (P0.05). There was no significant difference in the height of the intervertebral space between the unilateral and bilateral groups before and after the same time point (P0.05), but there was a significant difference in the height of the diseased space between the two groups at the last follow-up, and the difference was statistically significant (P0.05). There was no significant difference in bilateral group (P0.05). There was no discovery of pedicle screw loosening, release, and nail breaking. Conclusion: unilateral pedicle screw internal fixation combined with TLIF and bilateral fixation in the treatment of single segment lumbar degenerative disease is satisfactory, and unilateral TLIF has the advantages of short operation time, less bleeding during operation, short hospital time and so on. It is a good choice for the treatment of lumbar degenerative disease at one stage, but we should strictly grasp the indication.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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