PLIF椎板截骨回植术与PLIF椎板全切术治疗单节段腰椎退行性疾病的临床研究

发布时间：2018-06-16 07:58

本文选题：椎板截骨回植 + 硬膜外纤维化　；参考：《延安大学》2017年硕士论文

【摘要】：目的观察后路腰椎椎间融合(posterior lumbar interbody fusion,PLIF)椎板截骨回植术与PLIF椎板全切术治疗单节段腰椎退行性疾病的临床疗效,并对比观察术后硬膜外纤维化(epidural fibrosis,EF)和相邻节段退变(adjacent segment degeneration,ASD)发生率的差异,探讨应用PLIF治疗单节段腰椎退行性疾病的最佳手术方式。方法研究选取陕西省人民医院脊柱外科2009年1月至2014年1月期间应用PLIF椎板截骨回植术与PLIF椎板全切术治疗的单节段腰椎退行性疾病并获得完整随访的病例,根据本研究的纳入与排除标准回顾性分析167例病例资料。将全部病例根据手术方式的不同分为两组:椎板回植组(行PLIF椎板截骨回植术,纳入82例)和椎板全切组(行PLIF椎板全切术,纳入85例),两组除术式不同外余治疗、护理、随访完全一致。对比观察两组患者术前及术后1周、3月、6月、12月、24月、36月的疼痛视觉模拟评分(Visual analogue scale,VAS)、日本矫形外科学会(Japanese orthopaedic association,JOA)下腰痛评分、Oswestry功能障碍指数(Oswestry disability index,ODI)及影像学资料,分析两组临床疗效、椎间融合优良率及术后EF和ASD发生率的差异。所得数据均采用SPSS 18.0统计学软件处理分析,计量资料组间对比选择两独立样本t检验,组内对比选择配对样本t检验,计数资料对比选择χ2检验,检验水准设置为0.05。结果末次随访时两组患者VAS评分、JOA评分、ODI指数分别较术前显著改善,其差异均具有良好的统计学价值(P0.05)。椎板回植组末次随访时三项评分分别为(2.0±1.1)分、(24.0±1.8)分、(19.8±8.2)%,椎板全切组分别为(2.5±1.6)分、(23.3±2.0)分、(22.5±8.5)%,两组相比,三项评分均显示了良好的统计学差异性(P0.05)。Macnab优良率:椎板回植组为96.34%,椎板全切组为85.88%,两组相比其差异具有统计学意义(P0.05)。椎间融合优良率:椎板回植组为97.56%,椎板全切组为92.94%。随访过程中椎板回植组共出现16例EF,发生率为19.51%,椎板全切组共出现30例EF,发生率为35.29%,两组相比其差异具有统计学意义(P0.05);椎板回植组共出现20例ASD,发生率为24.39%,椎板全切组共出现37例ASD,发生率为43.53%,两组相比其差异具有统计学意义(P0.05)。末次随访时全部EF(+)ASD(-)患者的三项评分分别为(2.7±1.8)分、(22.0±1.9)分、(24.4±9.0)%,EF(-)ASD(+)患者分别为(2.9±1.5)分、(21.6±2.0)分、(25.7±8.7)%,其二者分别与EF(-)ASD(-)患者的(1.7±1.0)分、(25.6±1.6)分、(16.3±7.1)%相比,差异均显示出良好的统计学价值(P0.05)。结论本次课题回顾性研究了167例分别应用PLIF椎板截骨回植术与PLIF椎板全切术治疗的单节段腰椎退行性疾病的病例资料,两种术式均取得了理想的临床治疗效果。PLIF椎板截骨回植术与PLIF椎板全切术相比,具有更优的临床疗效和更低的术后EF及ASD发生率。本研究结果可为脊柱外科临床实践中单节段腰椎退行性疾病手术方式的选择提供参考,对指导手术规划、降低术后并发症发生率有重要的理论价值与临床意义。
[Abstract]:Objective To observe the clinical efficacy of posterior lumbar interbody fusion (posterior lumbar interbody fusion (PLIF) intervertebral osteotomy and PLIF laminectomy for the treatment of single segment lumbar degenerative disease, and to compare the incidence of postoperative epidural fibrosis (epidural fibrosis, EF) and adjacent segment degeneration (adjacent segment degeneration). The best surgical methods for the treatment of single segment lumbar degenerative disease with PLIF were studied. Methods study selected the cases of single segment lumbar degenerative disease treated by PLIF vertebral osteotomy and PLIF laminectomy during the period of January 2009 to January 2014 of Shaanxi People's Hospital. The inclusion and exclusion criteria of 167 cases were analyzed retrospectively. All cases were divided into two groups according to the different surgical methods: vertebral lamina replanting group (PLIF vertebral lamina osteotomy and replanting, 82 cases) and laminectomy group (PLIF laminectomy, included in 85 cases), the two groups were treated with different external treatment, nursing, and complete follow up. The two groups of patients were observed before and 1 weeks, March, June, December, 24 months, 36 months, Visual analogue scale, VAS, the Japanese Orthopedic Association (Japanese Orthopaedic Association, JOA) lower back pain score, Oswestry dysfunction index (Oswestry disability index,) and imaging data, analysis of two groups of clinical effects, The good rate of interbody fusion and the difference in the incidence of EF and ASD after the operation were analyzed by SPSS 18 statistics software, two independent sample t tests were selected between the groups of measurement data, the comparison selected paired sample t test, the count data contrast selection chi 2 test, and the test level set at the last follow-up of two groups of 0.05. results. The VAS score, the JOA score and the ODI index were significantly better than those before the operation (P0.05). The three scores of the vertebral lamina replanting group were (2 + 1.1), (24 + 1.8), (19.8 + 8.2)%, and (23.3 + 1.6), (23.3 + 2), (22.5 + 8.5)% respectively. The good rate of statistical difference (P0.05).Macnab was good: the vertebral lamina replanting group was 96.34%, the laminectomy group was 85.88%, and the difference between the two groups was statistically significant (P0.05). The good rate of intervertebral fusion was 97.56%, and the laminectomy group was 16 cases of EF in the vertebral lamina replanting group during the course of the 92.94%. visit. The incidence rate was 19.51%, There were 30 cases of EF in the laminectomy group, the incidence rate was 35.29%, and the difference between the two groups was statistically significant (P0.05); the vertebral lamina replanting group had 20 cases of ASD, the incidence was 24.39%, the total vertebral lamina resection group had 37 cases of ASD, the incidence was 43.53%, and the difference between the 35.29% groups was P0.05. At the last follow-up, all the EF (+) ASD (-) patients were three. The scores were (2.7 + 1.8), (22 + 1.9), (24.4 + 9)%, EF (-) ASD (+) patients were (2.9 + 1.5), (21.6 + 2), (25.7 + 8.7)%, respectively, and the difference showed good statistical value (P0.05) compared with EF (+) ASD (1.7 +)%, and (P0.05)%, respectively. Conclusion a retrospective study of this subject 167 cases of single segment lumbar degenerative disease treated with PLIF vertebral lamina osteotomy and PLIF laminectomy were used for the treatment of single segment lumbar degenerative disease. The two methods had achieved ideal clinical therapeutic effects. Compared with PLIF laminectomy,.PLIF vertebral lamina osteotomy replanting had better clinical efficacy and lower postoperative EF and ASD incidence. The results can provide reference for the selection of surgical methods for single segment lumbar degenerative disease in the clinical practice of spinal surgery. It has important theoretical value and clinical significance for guiding the operation planning and reducing the incidence of postoperative complications.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】