TLIF与PLIF治疗腰椎间盘突出症的临床疗效分析

发布时间：2018-05-25 19:27

本文选题：腰椎间盘突出症 + 经椎间孔椎体间融合(TLIF)　；参考：《新乡医学院》2015年硕士论文

【摘要】：背景腰椎间盘突出症是指由于腰椎髓核、纤维环、软骨终板以及周围韧带等随着年龄增长而出现退行性改变,最终导致腰腿痛、下肢放射疼等临床症状及体征为主要临床表现一类疾病。近年来,腰椎间盘疾病的发生率在人群中随着年龄的增长而逐步增加,其诊断与治疗已成为临床研究的焦点。国内外的骨科医师在腰椎间盘突出症的治疗中根据自已对腰椎间盘突出疾病的理解采用了不同的手术方法,在腰椎间盘摘除后又有如下融合术：如后外侧融合(Posterior lateral fusion,PLF),经后路椎体间融合(Posterior lumber interbody fusion,PLIF),经前路椎体间融合(Anterior lumbar interboby fusion,ALIF),经腰椎间孔椎间融合(Transforminal lumbar interboby fusion,TILF)等手术。但是怎样提高脊柱的稳定性,增加脊柱植骨的融合率,减少患者的创伤、缩短患者的病vR时间,提高其生活质量等一系列问题尚未得到完善的解决,而且各种手术方式均有优缺点。目的本研究收集因腰椎间盘间突出症而行经腰椎间孔椎间融合(TLIF)与后路椎体间融合(PLIF)两种手术方式的患者资料。探讨这两种手术方式对治疗腰椎间盘突出症的疗效优缺点。进行对比分析研究,为该种疾病治疗方式的选择提供依据。方法回顾性分析2012年10月-2014年6月入院治疗的腰椎间盘突出症患者80例临床资料。获得完整随访者80例,分为TLIF与PILF两组。每组40例。TLIF组给予TLIF术治疗；PLIF组给予PLIF术治疗。观察比较两组手术时间、术中出血量、卧床时间、椎体间融合率及融合时间等情况。结果TLIF组手术时间与术中出血量均少于PLIF组,差异有统计学意义(P0.05)TLIF组较PLIF组术后随访时Oswestry (ODI)障碍指数、VAS评分良好,差异有统计学意义(P0.05) TLIF组总有效率为90.0%,PLIF组总有效率为87.5%。差异有统计学意义(P0.05).所有患者术后3-6月影像学检查均显示椎间融合良好。其中TLIF组1例患者术后因发生车祸导致钉棒断裂。1例小腿外侧麻木,无切口感染,无脑脊液漏的发生。PLIF组术后患者内固定无一钉棒松动及断裂。2例小腿外侧麻木,1例患有脑脊液漏。有2例切口感染,使用抗生素以及勤加换药后患者恢复良好。结论两组椎间融合率高,保持了脊柱的稳定性。经腰椎间孔椎间融合术式(TLIF)较经后路椎体间融合术式(PLIF)手术时间短、术中出血量少值得临床推广应用。
[Abstract]:Background Lumbar disc herniation is a degenerative change of lumbar nucleus pulposus, fibrous ring, endplate of cartilage and surrounding ligament with age, which eventually leads to low back pain. Radiation pain and other clinical symptoms and signs are the main clinical manifestations of a disease. In recent years, the incidence of lumbar disc disease in the population with the increase of age, its diagnosis and treatment has become the focus of clinical research. In the treatment of lumbar disc herniation, orthopaedic physicians at home and abroad have adopted different surgical methods according to their own understanding of lumbar disc herniation. After lumbar discectomy, the following procedures were performed: posterolateral lateral fusion, posterior lumber interbody fusion, anterior lumbar interboby fusion and transforminal lumbar interboby fusion. However, how to improve the stability of the spine, increase the fusion rate of bone graft, reduce the trauma of patients, shorten the time of disease VR, improve their quality of life and a series of problems have not been solved. And all kinds of surgical methods have advantages and disadvantages. Objective to collect the data of patients with lumbar intervertebral disc herniation by transforaminal intervertebral fusion (TLIF) and posterior interbody fusion (PLIF). To explore the advantages and disadvantages of these two surgical methods in the treatment of lumbar disc herniation. A comparative study was carried out to provide a basis for the selection of treatment methods for the disease. Methods the clinical data of 80 patients with lumbar disc herniation from October 2012 to June 2014 were retrospectively analyzed. 80 cases were followed up completely and divided into two groups: TLIF and PILF. Each group of 40 cases. TLIF group was treated with TLIF and PLIF group was treated with PLIF. The operation time, blood loss, bed rest time, fusion rate and fusion time were observed and compared between the two groups. Results the time of operation and the amount of intraoperative bleeding in TLIF group were lower than those in PLIF group. The difference was statistically significant (P 0.05) compared with that in PLIF group (P 0.05). The index of Oswestry dysfunction was better than that in PLIF group. The difference was significant (P 0.05). The total effective rate of TLIF group was 90.0% and the total effective rate was 87.5%. The difference was statistically significant (P 0.05). 3-6 months after operation, all patients showed good intervertebral fusion. In the TLIF group, one patient suffered from a traffic accident after operation, which resulted in the fracture of the rod and the lateral numbness of the leg. There was no incision infection. No cerebrospinal fluid leakage occurred. In PLIF group, there was no loosening of nail and rod and no fracture. 2 cases had lateral leg numbness and 1 case had cerebrospinal fluid leakage. Two cases of incision infection recovered well after antibiotic use and frequent dressing change. Conclusion the rate of intervertebral fusion between the two groups is high and the stability of spine is maintained. The time of transforaminal interbody fusion (TLIF) is shorter than that of posterior interbody fusion (PLIF), and the less intraoperative bleeding is worth popularizing.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】