兰州大学机构库 >学院待认领
PLIF联合椎弓根螺钉治疗单节段腰椎间盘突出症的疗效分析
Alternative TitleCurative effect analysis of pedicle screw combined with posterior lumbar interbody fusion for the treatment of single-segment lumbar intervertebral disc herniation
杜小彪
Thesis Advisor王文己
2014-05-26
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword腰椎间盘突出症 全椎板减压 后路椎体间融合 椎弓根内固定
Abstract目的 观察腰椎后路全椎板减压髓核摘除椎间融合联合椎弓根螺钉内固定术对单节段腰椎间盘突出症的临床治疗效果。 方法 通过对我院自2012年3月到2012年12月间收治的71例确诊的单节段腰椎间盘突出症患者(L4/L5、L5/S1),其中男性45例,女性26例,年龄35~68岁,平均年龄51.2岁,病程6~30个月,平均18个月,其中L4/L5节段39例,L5/S1节段32例。所有患者行积极术前准备后在全麻下行腰椎后路髓核摘除椎间融合椎弓根螺钉内固定术,术后3月、6月、12月随访,行腰椎正侧位片,观察植骨融合情况以及椎间隙高度变化,通过JOA下腰痛评分以及JOA改善率评价临床疗效。 结果 本研究对71例病人进行了6个月到12个月的随访,平均随访时间为10个月。研究病例均未发生伤口感染,未发生神经根损伤,5例患者术中因周围组织与硬脊膜粘连紧密发生脑脊液漏,术中使用无损伤缝线缝合,伤口引流于术后72小时拔除,伤口加压包扎1周,采用头低脚高的体位,伤口均愈合良好。11例患者停用激素及脱水药物2-3天后出现患侧下肢疼痛、麻木感,给予对症治疗后上述症状逐渐缓解。末次随访未见断钉断棒及融合器移位。术后3月患者腰背痛、下肢疼痛、麻木症状均明显减轻,所有患者半年后恢复日常生活。植骨融合达Lenke标准A级者45例,占63.4%。B级22例,占31.0%。C级4例,占5.6%;术后3月椎间隙高度较术前明显增高,差异有显著统计学意义(P<0.05);与术后3月相比,术后12月椎间隙高度有变化,但差异无显著统计学意义(P>0.05);术后3月临床症状与术前相比较明显缓解,患者生活质量显著提高;与术前相比,JOA评分有了较明显的提高,差异具有统计学意义(P<0.05)。术后3月JOA改善率评定:优31例、良34例、中6例;术后12月JOA改善率评定:优49例、良20例、中2例。 结论 椎弓根内固定联合后路全椎板减压椎间融合术是治疗单节段腰椎间盘突出症的一种有效的手术方法。
Other AbstractObjective To evaluate the clinical effect of the PLIF combined with pedicle screw fixation for the surgical treatment of single-segment lumbar intervertebral disc herniation. Methods The study included 71 patients diagnosed with single-segment lumbar intervertebral disc herniation(L4/L5、L5/S1) who underwent surgical treatment in the spine surgery of our hospital from March 2012 to December 2012, including 45 males and 26 famales ranging from 35 to 68 years,the average age were 51.2 years.The patients had this disease for about 6 months to 30 months with a mean of 18 months.The total included 39 patients in L4/L5 and 32 patients in L5/S1. All patients underwent the posterior lumbar interbody fusion combined with pedicle screw fixation after positive preoperative preparation.we took lumbar X-ray graphs and let the patient fill in the JOA questionnaires after 3 months,6months and 12 months respectively,and through the result,we could evaluate the clinical efficacy by bone fusion, disc height, low back pain the Japanese Orthopaedic Association score (JOA score) and improvement rate of JOA. Results The Study of 71 cases of patients were followed up for 6 to 12 months, with an average of 10 months. All patients did not occur wound infection or nerve root injury. Cerebrospinal fluid leak happened in 5 patients because of intraoperative dural adhesions surrounding tissue, we used non-invasive surgery suture to repair it, unpluged wound drainage after 72 hours, and bandaged for one week , combined with the trendelenburg position, the wounds healed well. 11 patients occurred lowe limb pain or numbness, after disabling the hormone drugs and dehydration for 2-3 days ,when given symptomatic treatment,their symptoms were relieved.There were neither broken nails or rods nor cages displacement . Patients with low back pain, leg pain, numbness symptoms were significantly relieved 3 months later,all patients returned to normal lives after 6 months. By the fusion of Lenke standard ,Grade A,45 cases , accounting for 63.4% . Grade B ,22 cases, accounting for 31.0% . Grade C ,4 patients , accounting for 5.6% ; The height of the intervertebral space measured 3 months after surgery were significantly improved , the difference was statistically significant (P <0.05); The intervertebral space height changed 12 months later compared with the 3 months’, but the difference was not statistically significant significance (P> 0.05); The clinical symptoms of all patients w...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/223976
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
杜小彪. PLIF联合椎弓根螺钉治疗单节段腰椎间盘突出症的疗效分析[D]. 兰州. 兰州大学,2014.
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