早期下床活动对腰椎滑脱融合内固定术后疗效的影响

发布时间：2018-05-22 17:55

本文选题：腰椎滑脱 + 康复　；参考：《福建中医药大学》2015年硕士论文

【摘要】：目的：通过对比不同时间点下床活动对下腰椎滑脱融合内固定术后疗效的影响,为下腰椎滑脱融合内固定术后是否可以早期下床活动提供理论依据。方法：选取2013年8月至2014年4月在我院住院的75例腰椎滑脱行后路椎间融合内固定术的患者,其中男的39例,女的36例,平均年龄为42.4±5.3岁,均诊断为腰椎滑脱症,其中峡部裂型46例,退行性型29例。按照就诊顺序编为1-75号,采用区组随机化方法,按就诊先后顺序分配,将患者分为A组,B组,C组各25人。A组：术后第3天下床活动,B组：术后3周下床活动,C组：术后6周下床活动。评价指标包括术前及术后不同时间段的VAS及ODI评分,术后椎间融合率、椎弓根钉松动及断钉率,术后短期相关并发症(包括：腹胀、便秘、压疮、肺部感染,泌尿系感染,下肢静脉血栓)的发生率。结果：经方差分析和LSD法进行两两比较后,三组间术前VAS、ODI评分比较差异无统计学意义(均P0.05)。术后各时间段VAS、ODI评分比较差异均有统计学意义(均P0.05)。三组间术后VAS、ODI评分两两比较,差异均有统计学意义(均P0.05),且A组分值降低最明显；三组术后VAS、ODI评分与术前比较均明显降低,差异有统计学意义(均P0.05)；三组间术后腰椎功能改善率两两比较差异均有统计学意义(均P0.05),以A组腰椎功能改善最佳根据改良Brantigan评分标准,术后6个月A组椎间融合率为58.33%(14/24),B组为52.17%(12/23),C组为54.17%(13/24)。三组融合率比较差异无统计学意义(χ2=0.189,P0.05)；末次随访时,A组椎间融合率为79.16%(19/24),B组为73.91%(17/23),C组为70.83%(17/24)。两组融合率比较差异亦无统计学意义(χ2=0.450,P0.05)。本研究末次随访共有18例患者椎间未融合,其中14例患者存在轻度腰部疼痛,4例存在中度腰部疼痛,予口服非甾体类抗炎药止痛,疼痛明显缓解。术后随访示三组患者未发现椎弓根钉松动、断钉。三组患者术后短期并发症的比较有统计学意义,其中以A组发生率最低(P0.05)。结论：腰椎滑脱行后路减压复位融合内固定术后第3天在腰围保护及陪护的搀扶下下床活动可有效的减少术后疼痛,改善腰椎功能,降低术后短期并发症发生率。
[Abstract]:Objective: to compare the effect of different time points on the effect of lower lumbar spondylolisthesis fusion fixation, and to provide a theoretical basis for early decompression of lower lumbar spondylolisthesis fusion fixation. Methods: from August 2013 to April 2014, 75 patients with lumbar spondylolisthesis underwent posterior interbody fusion and internal fixation, including 39 males and 36 females, with an average age of 42.4 卤5.3 years, all of whom were diagnosed as lumbar spondylolisthesis. There were 46 cases of isthmic fissure type and 29 cases of degenerative type. According to the order of seeing a doctor, it was numbered 1-75. By using the method of block randomization, the group was assigned according to the order of seeing a doctor. The patients were divided into group A (n = 25) and group C (n = 25). Group A: get out of bed on the 3rd day after operation, group B: group C: 3 weeks after operation: group C: get out of bed 6 weeks after operation. The evaluation indexes included VAS and ODI scores before and after operation, intervertebral fusion rate, pedicle screw loosening and broken nail rate, postoperative short-term complications (including abdominal distension, constipation, pressure sore, pulmonary infection, urinary tract infection), postoperative complications (including abdominal distension, constipation, pressure sore, pulmonary infection, urinary tract infection). The incidence of venous thrombosis in the lower extremity. Results: there was no significant difference in preoperative VAS-ODI scores between the three groups by ANOVA and LSD (all P 0.05). There were significant differences in VASG ODI scores in all postoperative periods (all P 0.05). There were significant differences between the three groups in VAS-ODI score (P0.05%, group A, P < 0.05), the scores of VAS-ODI in group A were significantly lower than those before operation, and the scores were significantly lower in group A than in group A (P < 0.05), and the scores were significantly lower in group A than in group A (P < 0.05). The difference was statistically significant (all P 0.05), and the improvement rate of lumbar vertebrae function was significantly different among the three groups (all P 0.05). The best improvement of lumbar function in group A was based on the improved Brantigan score. 6 months after operation, the intervertebral fusion rate of group A was 58.33% and that of group B was 52.17%, and that of group C was 54.17%, and that of group C was 54.17%. There was no significant difference in the fusion rate among the three groups (蠂 ~ 2 / 0.189 / P 0.05), and the intervertebral fusion rate of group A was 79.16 / 19 / 24 and that of group B was 73.91 / 17 / 23 and that of group C was 70.83 / 24 / 24 at the last follow-up. There was no significant difference in fusion rate between the two groups (蠂 2 0. 450 P 0 05). In the last follow-up, 18 patients were not intervertebral fusion, 14 of them had mild lumbar pain, 4 had moderate waist pain, and were treated with oral NSAIDs to relieve the pain. The follow-up showed that the pedicle nail was not loosened or broken in the three groups. There was significant difference in the short-term postoperative complications among the three groups, among which group A had the lowest incidence (P 0.05). Conclusion: lumbar spondylolisthesis with posterior decompression, reduction, fusion and internal fixation can effectively reduce postoperative pain, improve lumbar function and reduce the incidence of postoperative short-term complications.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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