腰椎悬浮固定与腰骶部固定术后邻近节段退变的临床研究
发布时间：2018-11-14 09:38
【摘要】：目的:对照研究悬浮固定与腰骶部固定两种融合手术方式在治疗腰骶椎退行性病变的中期临床疗效,以及术后对腰骶椎邻近节段退变的影响。方法:回顾性分析研究广东省中医院骨一科在2010年1月至2014年12因腰骶椎退行性病变(腰椎间盘突出症、腰椎管狭窄症、退变性腰椎滑脱症)的病人,选取符合纳入条件患者共84例,其中腰椎悬浮固定组(观察组)42例,腰骶部固定组(对照组)42例。通过采集术前及随访时的相关临床资料,采用VAS、J0A评分标准,评估两种手术方式的临床疗效;通过收集术前及各个随访时间段的腰椎正侧位、动力位X光片以及腰椎MRI,分别测量内固定手术上位节段和下位节段的椎间隙高度(H)、腰椎活动度(ROM)、腰椎前凸角(LL)、骨盆入射角(PI)、术前骨盆入射角与腰椎前凸角差值(ΔPILL),再运用UCLA椎间隙退变分级标准在腰椎X光片上进行分析评分。记录两组病例术前及末次随访时的各项指标情况,使用EXCEL 2007软件建立数据库并用SPSS 21.0软件进行统计分析,比较两组术前与末次随访时各项指标组内及组间的差异,当P0.05被认为具有统计学意义。结果:腰椎悬浮固定组(观察组)与腰骶部固定组患者(对照组)的一般资料(年龄、性别、BMI、病程、手术时间、住院天数、随访时间、术中出血量、术前诊断)比较中无统计学差异(P0.05),基线平衡,提示两组资料之间具有可比性。观察组术前J0A评分、腰痛VAS评分、腿痛VAS评分分别是16.98±2.25、3.74±1.70、5.05土1.51,末次随访时为25.17±1.78、0.68±0.56、0.76±0.59,组内差异性均有统计学意义(P0.01)。对照组术前J0A评分、腰痛VAS评分、腿痛VAS评分分别是 16.93土2.68、3.96土2.03、5.12±1.48,末次随访时为 24.97±1.65、0.67±0.60、0.83±0.56,组内差异性均有统计学意义(P0.01)。在随访期间共有34例患者发生邻近节段退变,平均发生于术后随访第24.50士12.95月。在观察组中,ASDeg的发病率为26.19%(11/42),ASDis的发病率为19.05%(8/42),8例ASDis中仅有1例行再次手术治疗。而在对照组中,ASDeg的发病率为4.76%(2/42),ASDis的发病率为30.95%(13/42),13例ASDis中有3例因明显下肢放射性疼痛行翻修手术,两组间差异具有统计学意义(P0.05)。△PILL的受试者工作特征曲线产生的AUC面积为0.797,提示ΔPILL对术后邻近节段退变的诊断价值中等。当最佳临界点为19.1°时,对术后邻近节段退变的灵敏度为85.7%,特异度为75.7%,阳性预测值为87.3%,阴性预测值为93.1%。以最佳临界点为分组依据,术前△PILL19.1°组有55例,术后有7例发生邻近节段退变,发病率为12.7%;而术前△PILL19.1°组中,术后发生邻近节段退变的患者有32例,发病率为93.1%。差异性有统计学意义(P0.01)。结论:腰椎悬浮固定与腰骶部固定两种融合内固定手术方式在治疗腰骶部退行性病变上均可获得良好的中期临床疗效,且两者效果相当。两种术式在术后均发生不同程度的影像学邻近节段退变,其中悬浮固定组的邻近节段更容易发生影像学上的退变,但术后因退变所导致的下肢根性疼痛症状在腰骶部固定组更多见。术前骨盆入射角与腰椎前凸角差值更大的患者,术后更易于发生邻近节段退变。
[Abstract]:Objective: To study the mid-term clinical effect of two fusion-operation methods in the treatment of the degenerative diseases of the lumbar intervertebral disc and the effect of the post-operation on the detransformation of the adjacent segment of the lumbar vertebra. Methods: The patients with degenerative lumbar disc disease (lumbar disc herniation, lumbar spinal stenosis, degenerative lumbar spondylolisthesis) from January 2010 to December 2014 were analyzed retrospectively, and 84 cases were selected according to the conditions of inclusion. Among them, 42 cases of the lumbar suspension fixation group (observation group) and 42 cases of the lumbar spinal fixation group (control group) were observed. The clinical efficacy of the two methods of operation was evaluated by using the VAS and J0A scoring criteria before and during the follow-up period, and the positive lateral position of the lumbar vertebra, the power position X-ray film and the lumbar vertebra MRI before and after the operation were collected. respectively measuring the intervertebral space height (H), the lumbar motion (ROM), the lumbar lordosis (LL), the pelvic angle of incidence (PI), the pre-operative pelvic angle of incidence and the lumbar lordosis (pILL) of the upper and lower segments of the internal fixation operation, and then the UCLA intervertebral space degrading standard is used for performing the analysis and grading on the lumbar vertebra X-ray film. The indexes of the two groups were recorded before and after the last follow-up. The database was established by using the EXCEL 2007 software and the statistical analysis was made with the SPSS 10.0 software. The difference between the two groups and the group was compared between the two groups before and after the last follow-up. Results: The general data (age, sex, BMI, course of course, operation time, number of days of stay, follow-up time, intraoperative blood loss, pre-operative diagnosis) of the lumbar suspension fixation group (observation group) and the fixed group of the lumbar vertebra (control group) were not statistically different (P0.05), and the baseline balance, Prompt for comparability between the two groups of data. The preoperative J0A score, the back pain VAS score and the leg pain VAS score of the observation group were 16.98, 2.25, 3.74, 1.70, 5.05, 1.51, and 25.17, 1.78, 0.68, 0.56, 0.76 and 0.59 in the last follow-up, respectively (P0.01). In the control group, the preoperative J0A score, the back pain VAS score and the leg pain VAS score were 16.93, 2.68, 3.96, 2.03, 5.12 and 1.48, and the difference in the group was 24.97, 1.65, 0.67, 0.60, 0.83 and 0.56, respectively (P0.01). In the follow-up period, a total of 34 patients had an adjacent segment withdrawal, with an average of 24. 50 + 12. 95 months follow-up. In the observation group, the incidence of ASDeg was 26. 19% (11/ 42), the incidence of ASDis was 19.05% (8/ 42), and only 1 of the 8 ASDs was treated again. In the control group, the incidence of ASDeg was 4.76% (2/ 42), the incidence of ASDis was 30. 95% (13/ 42), and 3 of the 13 ASDs were revision surgery due to the significant lower limb radioactive pain, and the difference between the two groups was statistically significant (P0.05). The area of the AUC generated by the subject's working characteristic curve for PILL was 0.797, suggesting a moderate value of the diagnostic value of pILL for the devariable of the adjacent segment after the procedure. When the optimal critical point was 19. 1 掳, the sensitivity of the devariable to the adjacent segment after operation was 85.7%, the specificity was 75.7%, the positive predictive value was 87.3%, and the negative predictive value was 93.1%. On the basis of the optimal critical point, there were 55 cases in the preoperatively PILL19. 1 degree group, 7 cases of the post-operative treatment of the adjacent segment and the incidence rate of 12.7%, and 32 of the patients with the adjacent segment after the operation, with the incidence of 93.1%. The difference was significant (P0.01). Conclusion: The two fusion internal fixation methods of the lumbar suspension fixation and the lumbar spinal fixation are effective in the treatment of the degenerative diseases of the lumbar intervertebral disc, and the effect is comparable. The two methods have different degree of image adjacent segment dedifferentiation after the operation, in which the adjacent segment of the suspended fixation group is more prone to image regression, but the symptoms of the lower limb radicular pain caused by the demotion after the operation are more commonly seen in the fixed group of the waist part. The pre-operative pelvic angle of incidence is greater than that of the lumbar lordosis, and it is easier for the post-operative to take place adjacent to the segment.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
，
本文编号：2330804
[Abstract]:Objective: To study the mid-term clinical effect of two fusion-operation methods in the treatment of the degenerative diseases of the lumbar intervertebral disc and the effect of the post-operation on the detransformation of the adjacent segment of the lumbar vertebra. Methods: The patients with degenerative lumbar disc disease (lumbar disc herniation, lumbar spinal stenosis, degenerative lumbar spondylolisthesis) from January 2010 to December 2014 were analyzed retrospectively, and 84 cases were selected according to the conditions of inclusion. Among them, 42 cases of the lumbar suspension fixation group (observation group) and 42 cases of the lumbar spinal fixation group (control group) were observed. The clinical efficacy of the two methods of operation was evaluated by using the VAS and J0A scoring criteria before and during the follow-up period, and the positive lateral position of the lumbar vertebra, the power position X-ray film and the lumbar vertebra MRI before and after the operation were collected. respectively measuring the intervertebral space height (H), the lumbar motion (ROM), the lumbar lordosis (LL), the pelvic angle of incidence (PI), the pre-operative pelvic angle of incidence and the lumbar lordosis (pILL) of the upper and lower segments of the internal fixation operation, and then the UCLA intervertebral space degrading standard is used for performing the analysis and grading on the lumbar vertebra X-ray film. The indexes of the two groups were recorded before and after the last follow-up. The database was established by using the EXCEL 2007 software and the statistical analysis was made with the SPSS 10.0 software. The difference between the two groups and the group was compared between the two groups before and after the last follow-up. Results: The general data (age, sex, BMI, course of course, operation time, number of days of stay, follow-up time, intraoperative blood loss, pre-operative diagnosis) of the lumbar suspension fixation group (observation group) and the fixed group of the lumbar vertebra (control group) were not statistically different (P0.05), and the baseline balance, Prompt for comparability between the two groups of data. The preoperative J0A score, the back pain VAS score and the leg pain VAS score of the observation group were 16.98, 2.25, 3.74, 1.70, 5.05, 1.51, and 25.17, 1.78, 0.68, 0.56, 0.76 and 0.59 in the last follow-up, respectively (P0.01). In the control group, the preoperative J0A score, the back pain VAS score and the leg pain VAS score were 16.93, 2.68, 3.96, 2.03, 5.12 and 1.48, and the difference in the group was 24.97, 1.65, 0.67, 0.60, 0.83 and 0.56, respectively (P0.01). In the follow-up period, a total of 34 patients had an adjacent segment withdrawal, with an average of 24. 50 + 12. 95 months follow-up. In the observation group, the incidence of ASDeg was 26. 19% (11/ 42), the incidence of ASDis was 19.05% (8/ 42), and only 1 of the 8 ASDs was treated again. In the control group, the incidence of ASDeg was 4.76% (2/ 42), the incidence of ASDis was 30. 95% (13/ 42), and 3 of the 13 ASDs were revision surgery due to the significant lower limb radioactive pain, and the difference between the two groups was statistically significant (P0.05). The area of the AUC generated by the subject's working characteristic curve for PILL was 0.797, suggesting a moderate value of the diagnostic value of pILL for the devariable of the adjacent segment after the procedure. When the optimal critical point was 19. 1 掳, the sensitivity of the devariable to the adjacent segment after operation was 85.7%, the specificity was 75.7%, the positive predictive value was 87.3%, and the negative predictive value was 93.1%. On the basis of the optimal critical point, there were 55 cases in the preoperatively PILL19. 1 degree group, 7 cases of the post-operative treatment of the adjacent segment and the incidence rate of 12.7%, and 32 of the patients with the adjacent segment after the operation, with the incidence of 93.1%. The difference was significant (P0.01). Conclusion: The two fusion internal fixation methods of the lumbar suspension fixation and the lumbar spinal fixation are effective in the treatment of the degenerative diseases of the lumbar intervertebral disc, and the effect is comparable. The two methods have different degree of image adjacent segment dedifferentiation after the operation, in which the adjacent segment of the suspended fixation group is more prone to image regression, but the symptoms of the lower limb radicular pain caused by the demotion after the operation are more commonly seen in the fixed group of the waist part. The pre-operative pelvic angle of incidence is greater than that of the lumbar lordosis, and it is easier for the post-operative to take place adjacent to the segment.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
，
本文编号：2330804
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