退行性腰椎侧凸后路长节段固定不同上端固定椎选择比较的研究
发布时间：2018-10-21 17:14
【摘要】：目的 对退行性腰椎侧凸(Degenerative Lumbar Scoliosis, DLS)后路长节段融合内固定不同上端固定椎选择进行研究,探讨不同上端固定椎对临床疗效的影响。 方法 回顾分析2008年至2014年期间在本科室进行后路长节段融合内固定治疗退行性腰椎侧凸患者,根据术前术后全脊柱摄片不同上端固定椎,分为A,B两组：A组特点为融合至上胸椎(upper thoracic, UT)(T10及以上),B组特点为融合至下胸椎(lower thoracic, LT)(T10以下)。平均融合节段分别为：8.5和5.6.分别记录两组手术操作时间(min),术中出血量(m1),术前与术后Cobb角,术前与术后Oswestry功能障碍指数评分(oswestry disability index, ODI),术前与术后胸椎后凸角(thoracic kyphosis, TK),术前与术后腰椎前凸角(lumbar lordosis, LL),术前与术后交界性后凸角(proximal junctional kyphosis, PJK),术前与术后矢状位垂直轴(sagittal verticalaxis, SVA),术前与术后骨盆倾斜角(pelvic title, PT),并统计与分析两组术后并发症的发生率。 结果 共有30例符合条件的病例入组本研究,其中男13例,女17例,其中选择上端胸椎为固定椎(upper thoracic,UT)记为A组15例,选择下端胸椎为固定椎(lower thoracic,LT)B组15例,A组手术年龄66.4±6.5岁,B组手术年龄68.4±5.1岁,成人退行性腰椎侧凸后路长节段融合内固定选择上胸椎与选择下胸椎相比,A组手术操作时间(380.8±20.3mmin)比B组操作时间(240.8±10.3min)更长[P0.05],A组术中出血(1658.7±201.1m1)比B组术中出血(1325.8±101.2m1)更多[P0.05],两组术后Oswestry功能障碍指数评分(oswestry disability index,ODI)较术前相比[P0.05]和有[P0.05]均有明显改善,差异有统计学意义。两组术后ODI评分[P=0.15]相比,差异无明显统计学意义。两组术后Cobb角较术前相比[P0.01]和有[P0.01]明显改善,差异有统计学意义。两组术后Cobb角[P=0..48]相比,差异无统计学意义。两组胸椎后凸角(thoracic kyphosis,TK)[P=0.68],术后交界性后凸角(proximaljunctional kyphosis,PJK)[P=0.25],术后腰椎前凸角(lumbar lordosis,LL)[P=0.45],术后矢状位垂直轴(sagittal vertical axis,SVA)[P=0.21],术后骨盆倾斜角(pelvic title,PT)[P=0.58]相比,差异均无统计学意义。 结论 对退行性腰椎侧凸长节段固定患者,选择T10为近端固定椎能达到与T10以上椎相似的脊柱矢状面参数矫正效果,且具有手术时间短、出血量少的优势。
[Abstract]:Objective to study the choice of long segment fusion internal fixation for different upper end fixation of degenerative lumbar scoliosis (Degenerative Lumbar Scoliosis, DLS), and to explore the effect of different upper fixation on clinical efficacy. Methods from 2008 to 2014, the patients with degenerative lumbar scoliosis were treated with posterior long segment fusion and internal fixation. Group A was divided into two groups: group A was characterized by fusion of upper thoracic vertebra (upper thoracic, UT) (T10 and), B group with fusion to lower thoracic vertebra (lower thoracic, LT) (T10. The mean fusion segments were 8.5 and 5.6, respectively. Blood loss (M1), preoperative and postoperative Cobb angles were recorded in two groups during (min), operation. Preoperative and postoperative Oswestry dysfunction Index score (oswestry disability index, ODI), preoperative and postoperative thoracic kyphosis angle (thoracic kyphosis, TK), preoperative and postoperative lumbar kyphosis angle (lumbar lordosis, LL), preoperative and postoperative borderline kyphosis angle (proximal junctional kyphosis, PJK), preoperative and postoperative sagittal vertical axis The incidence of postoperative complications was analyzed by (pelvic title, PT), before and after (sagittal verticalaxis, SVA),. Results A total of 30 eligible cases were included in this study, including 13 males and 17 females. The upper thoracic vertebra was selected as fixed vertebra (upper thoracic,UT) in group A (15 cases). The lower thoracic vertebra was selected as the fixed vertebra (lower thoracic,LT) group B (15 cases). The operative age of group A was 66.4 卤6.5 years old, and that of group B was 68.4 卤5.1 years old. The operative time of group A (380.8 卤20.3mmin) was longer than that of group B (240.8 卤10.3min), the operative time of group A (1658.7 卤201.1m1) was more than that of group B (1325.8 卤101.2m1) [P0.05]. The scores of Oswestry dysfunction index (oswestry disability index,ODI) in group A were significantly improved compared with those before [P0.05] and (P0.05). The difference is statistically significant. There was no significant difference in ODI score between the two groups. The postoperative Cobb angle of the two groups was significantly improved compared with the preoperative ones (P 0.01 and P 0.01). There was no significant difference in Cobb angle between the two groups. There was no significant difference in thoracic kyphosis angle (thoracic kyphosis,TK), borderline kyphosis angle (proximaljunctional kyphosis,PJK), lumbar spine kyphosis angle (lumbar lordosis,LL), sagittal vertical axis (sagittal vertical axis,SVA) and pelvic obliquity angle (pelvic title,PT) between the two groups. Conclusion for the patients with long segmental degenerative lumbar scoliosis, the choice of T10 as proximal fixation can achieve the correction effect of sagittal parameters similar to that of T10, and has the advantages of short operation time and less bleeding.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2285802
[Abstract]:Objective to study the choice of long segment fusion internal fixation for different upper end fixation of degenerative lumbar scoliosis (Degenerative Lumbar Scoliosis, DLS), and to explore the effect of different upper fixation on clinical efficacy. Methods from 2008 to 2014, the patients with degenerative lumbar scoliosis were treated with posterior long segment fusion and internal fixation. Group A was divided into two groups: group A was characterized by fusion of upper thoracic vertebra (upper thoracic, UT) (T10 and), B group with fusion to lower thoracic vertebra (lower thoracic, LT) (T10. The mean fusion segments were 8.5 and 5.6, respectively. Blood loss (M1), preoperative and postoperative Cobb angles were recorded in two groups during (min), operation. Preoperative and postoperative Oswestry dysfunction Index score (oswestry disability index, ODI), preoperative and postoperative thoracic kyphosis angle (thoracic kyphosis, TK), preoperative and postoperative lumbar kyphosis angle (lumbar lordosis, LL), preoperative and postoperative borderline kyphosis angle (proximal junctional kyphosis, PJK), preoperative and postoperative sagittal vertical axis The incidence of postoperative complications was analyzed by (pelvic title, PT), before and after (sagittal verticalaxis, SVA),. Results A total of 30 eligible cases were included in this study, including 13 males and 17 females. The upper thoracic vertebra was selected as fixed vertebra (upper thoracic,UT) in group A (15 cases). The lower thoracic vertebra was selected as the fixed vertebra (lower thoracic,LT) group B (15 cases). The operative age of group A was 66.4 卤6.5 years old, and that of group B was 68.4 卤5.1 years old. The operative time of group A (380.8 卤20.3mmin) was longer than that of group B (240.8 卤10.3min), the operative time of group A (1658.7 卤201.1m1) was more than that of group B (1325.8 卤101.2m1) [P0.05]. The scores of Oswestry dysfunction index (oswestry disability index,ODI) in group A were significantly improved compared with those before [P0.05] and (P0.05). The difference is statistically significant. There was no significant difference in ODI score between the two groups. The postoperative Cobb angle of the two groups was significantly improved compared with the preoperative ones (P 0.01 and P 0.01). There was no significant difference in Cobb angle between the two groups. There was no significant difference in thoracic kyphosis angle (thoracic kyphosis,TK), borderline kyphosis angle (proximaljunctional kyphosis,PJK), lumbar spine kyphosis angle (lumbar lordosis,LL), sagittal vertical axis (sagittal vertical axis,SVA) and pelvic obliquity angle (pelvic title,PT) between the two groups. Conclusion for the patients with long segmental degenerative lumbar scoliosis, the choice of T10 as proximal fixation can achieve the correction effect of sagittal parameters similar to that of T10, and has the advantages of short operation time and less bleeding.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前2条
1 夏良政;徐宏光;;退变性脊柱侧弯自然史与治疗[J];国际骨科学杂志;2006年03期
2 王智方;胡侦明;郝杰;陈林;汪礼军;张晓军;甘强;何斌;;经椎弓根内固定治疗退行性腰椎侧凸并椎管狭窄症[J];中国组织工程研究;2014年17期
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