腰椎后路椎管减压椎体间融合术流程优化对出血量及疗效影响的临床研究

发布时间：2018-11-25 21:24

【摘要】：目的:探讨流程优化后腰椎后路椎管减压椎体间融合术治疗腰椎退行性疾病的安全性和有效性。方法:将收集到的符合纳入标准的需行腰椎后路椎管减压椎体间融合术的成年患者病例进行回顾性分析。按照手术方式的不同,分为流程优化组(59例)及传统融合组(60例),再根据融合节段数分为三组:单节段、双节段和2个节段。分别记录患者的术中出血量、术后引流量、输血量、红细胞比容、术后并发症(切口感染、神经根损伤、硬脊膜损伤)、手术前后VAS及JOA评分、Macnab疗效分级的等级例数、术后融合率及邻近节段退变发生数。采用SPSS17.0统计软件对上述资料进行统计分析。结果:(1)组内比较:同组内各亚组间术中出血量、术后引流量、隐性失血量与输血量均差异存在统计学意义(P0.05);同组内各亚组间末次随访时VAS及JOA评分均较术前明显改善(P0.05),但手术前、后VAS及JOA评分差异无统计学意义(P0.05);随着融合节段的增加,同组各亚组间并发症及融合率无明显差异,但2个节段组邻近节段退变发生率高于其它两个亚组。(2)组间比较:所有患者均获得良好的随访;两组间同节段亚组术中出血量、术后引流量、隐性失血量与输血量均差异存在统计学意义(P0.05);在手术前后VAS及JOA评分、Macnab疗效分级优良率方面,两组间差异无统计学意义(P0.05);并发症方面,传统融合术中硬脊膜损伤及术后3d下肢神经功能障碍高于流程优化组;两组患者术后均获得良好的融合率,但流程优化组术后邻近节段退变发生率明显低于传统融合组。结论:流程优化后腰椎后路减压椎体间融合术与传统融合术治疗腰椎退行性疾病均是行之有效的治疗方案,但流程优化后腰椎后路减压椎体间融合术对软组织及骨性结构破坏小、出血少,不仅能够解决血源紧张的态势,还可以降低神经根及硬脊膜损伤发生率,减缓术后邻近节段退变的速度。
[Abstract]:Objective: to evaluate the safety and efficacy of posterior lumbar decompression and interbody fusion in the treatment of lumbar degenerative diseases. Methods: the collected adult patients with lumbar spinal canal decompression and interbody fusion were retrospectively analyzed. According to the different operation methods, they were divided into two groups: flow optimization group (59 cases) and traditional fusion group (60 cases). According to the number of fusion segments, they were divided into three groups: single segment, double segment and two segments. The intraoperative bleeding volume, postoperative drainage volume, blood transfusion volume, specific volume of red blood cells, postoperative complications (incision infection, nerve root injury, dural injury), VAS and JOA scores before and after operation, and the number of Macnab grade were recorded respectively. The rate of postoperative fusion and the incidence of adjacent segment degeneration. The above data were analyzed by SPSS17.0 software. Results: (1) Intra-group comparison: there were significant differences in intraoperative blood loss, postoperative drainage volume, recessive blood loss and blood transfusion volume among subgroups in the same group (P0.05). The scores of VAS and JOA at the last follow-up in the same group were significantly improved compared with those before operation (P0.05), but there was no significant difference in VAS and JOA scores before and after operation (P0.05). With the increase of fusion segments, there was no significant difference in complications and fusion rates among subgroups of the same group, but the incidence of degeneration of adjacent segments in the two subgroups was higher than that in the other two subgroups. (2) comparison between groups: all the patients were followed up well; There were significant differences in intraoperative blood loss, postoperative drainage volume, recessive blood loss and blood transfusion volume between the two groups (P0.05). There was no significant difference between the two groups in the scores of VAS and JOA before and after operation and the excellent and good rate of Macnab grade (P0.05), the complications of the two groups were higher than those in the traditional fusion group in dural injury and lower extremity neurological dysfunction 3 days after operation. Good fusion rate was obtained in both groups, but the incidence of postoperative adjacent segment degeneration in the process optimization group was significantly lower than that in the traditional fusion group. Conclusion: both posterior decompression and interbody fusion are effective in the treatment of lumbar degenerative diseases. But the posterior decompression and interbody fusion of lumbar vertebrae can not only solve the situation of blood tension, but also reduce the incidence of nerve root and dural injury. The degenerative rate of adjacent segment after operation was slowed down.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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