腰椎后路不同节段固定方式治疗退变性腰椎侧凸的临床效果分析

发布时间：2018-05-24 04:29

本文选题：退行性腰椎侧凸 + 内固定融合术　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:系统评估腰椎后路减压固定融合在退变性腰椎侧凸治疗中的临床效果,同时对长节段和短节段固定融合方式的术后疗效进行对比,为退变性腰椎侧凸的治疗及预防提供经验及理论依据。方法:综合分析吉林大学第二医院脊柱外科2013年2月-2016年7月间39例退变性腰椎侧凸患者的临床及影像学资料,所有患者均在保守治疗无效后,针对患者个体化情况进行不同节段的腰椎后路减压固定融合术。通过患者术中固定节段数目将患者分为两组(长节段组与短节段固定组),长节段融合固定组病例数24例,平均5.4±1.3个节段,短节段融合固定组病例数15例,平均2.3±1.1个节段。以上患者在术前及术后均完善了MRI、CT、X线等检查,利用Cobb法测量法对所有患者术前及术后腰椎侧凸角、前凸角进行测量,根据其测量值分别计算出改善率加以分析,详细记录手术用时、失血量、伤口引流量等参数,同时对所有患者术后进行3-18月不等的术后随访完善症状视觉模拟评估Oswestry功能障碍指数(ODI)、JOA下腰痛评分等评价指标。所有数据利用SPSS19.0统计学软件进行统计学分析(检验水准设为a=0.05),通过对各组患者Cobb角、前凸角、JOA评分、ODI评分等参数进行对比与观察,研究不同节段固定融合方式在退行性腰椎侧凸治疗中的差异,为临床上退变性腰柱侧凸手术治疗方式的选择提供理论基础。结果:通过对所有病例数据进行分析及患者术后3-18个月的随访,所有所选病例手术均顺利完成,所有患者对治疗效果满意,患者症状得到明显改善。术后JOA评分、ODI评分较术前明显改善(P0.05);通过对术中患者出血量及手术时间进行分析,长节段固定组手术时间及出血量显著大于短节段固定组(P0.05);通过对长、短节段固定两组患者JOA评分、ODI评分改善率进行分析,二者在改善患者临床症状上无明显差别;长节段固定组术前Cobb角度24.13~36.77°,平均30.45±6.32°,术后随访测得平均Cobb角度数11.4±1.95,改善率62.5±6.17%,短节段固定组术前Cobb角度数14.71~21.69°,平均18.2±3.49°,术后随访测得平均Cobb角度数10.11±1.6°,改善率44.45±2.55%,两组患者Cobb角改善率有统计学差异(P0.05);长节段固定组术前腰椎前凸角平均值为19.44±6.55°,术后随访测得平均值为29.3±3.81°,短节段固定组术前腰椎前凸角平均值为21.67±3.01°,术后随访测得平均值为30.25±4.7°,二者前凸角改善程度无明显差别(P0.05)。结论:腰椎后路减压固定融合术在退变性腰椎侧凸治疗中具有非常显著的疗效,其能够在最大程度上改善患者疼痛、神经压迫等临床症状。相对于短节段固定融合组,长节段固定融合能够更好的矫正腰椎侧凸,但其术中出血量的增加及手术时间的延长在一定程度上增加了手术的风险及并发症发生率,因此在腰椎退变性侧凸的治疗中应严格把握适应症,针对患者个人情况合理制定手术策略。
[Abstract]:Objective: to evaluate the clinical effect of lumbar posterior decompression and fixation fusion in the treatment of degenerative lumbar scoliosis, and to compare the effect of long and short segmental fixation fusion. To provide experience and theoretical basis for the treatment and prevention of degenerative lumbar scoliosis. Methods: the clinical and imaging data of 39 patients with degenerative lumbar scoliosis from February 2013 to July 2016 in the Department of Spinal surgery, the second Hospital of Jilin University, were analyzed. Different levels of posterior lumbar decompression and fixation fusion were performed according to the individual condition of the patients. The patients were divided into two groups (long segment group and short segment fixation group, 24 cases in long segment fusion fixation group (mean 5.4 卤1.3 segment), 15 cases in short segment fusion fixation group (average 2.3 卤1.1 segment). All the above patients had improved the MRI CT X-ray examination before and after operation. All the patients were measured by Cobb method. The improvement rate was calculated and analyzed according to the measured values of the lumbar kyphosis angle and anterior kyphosis angle of all the patients before and after operation. The parameters of blood loss and wound drainage were recorded in detail. All patients were followed up from 3 to 18 months after operation. Visual simulation was performed to evaluate the Oswestry dysfunction index and low back pain score. All the data were analyzed by SPSS19.0 statistical software (the test level was set as a0. 05). The parameters such as Cobb angle, protruding angle and SPSS19.0 score were compared and observed. To study the differences of different segmental fixation fusion in the treatment of degenerative lumbar scoliosis, and to provide a theoretical basis for the choice of surgical treatment for degenerative lumbar scoliosis. Results: through the analysis of the data of all cases and the follow-up of the patients from 3 to 18 months after operation, all the selected cases were successfully completed, all the patients were satisfied with the therapeutic effect and the symptoms of the patients were obviously improved. The postoperative JOA score was significantly improved than that before operation (P 0.05). By analyzing the blood loss and operation time of the patients in the long segment fixation group, it was found that the operation time and the amount of blood loss in the long segment fixation group were significantly larger than that in the short segment fixation group, and the results showed that the blood loss in the long segment fixation group was significantly higher than that in the short segment fixation group. The improvement rate of JOA score and ODI score in the two groups were analyzed. There was no significant difference in the improvement of clinical symptoms between the two groups. The preoperative Cobb angle in the long segment fixation group was 24.1336.77 掳(mean 30.45 卤6.32 掳). The average Cobb angle was 11.4 卤1.95, and the improvement rate was 62.5 卤6.17 掳. In the short segment fixation group, the preoperative Cobb angle was 14.71 卤21.69 掳(18.2 卤3.49 掳). The average Cobb angle was 10.11 卤1.6 掳and the improvement rate was 44.45 卤2.55 掳. There was significant difference in the rate of angle improvement in the long segment fixation group (19.44 卤6.55 掳before operation, 29.3 卤3.81 掳in the postoperative follow-up, 21.67 卤3.01 掳in the short segment fixation group, and 30.25 卤4.7 掳in the follow-up after operation), there was a significant difference in the angle improvement rate (P 0.05), and the mean value of lumbar kyphosis angle was 19.44 卤6.55 掳in the long segment fixation group, 29.3 卤3.81 掳in the postoperative follow-up, and 21.67 卤3.01 掳in the short segment fixation group. There was no significant difference in the improvement of kyphosis angle between the two groups (P 0.05). Conclusion: posterior lumbar decompression and fixation fusion is very effective in the treatment of degenerative lumbar scoliosis. Compared with the short segment fixation fusion group, the long segment fixation fusion can better correct lumbar scoliosis, but the increase of intraoperative blood loss and the prolongation of operation time increase the risk of operation and the incidence of complications to a certain extent. Therefore, in the treatment of lumbar degenerative scoliosis, the indication should be strictly grasped and the operation strategy should be made according to the individual situation of the patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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