传统后正中入路腰椎管狭窄症手术治疗的疗效评价
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摘要
目的:观察腰椎管狭窄症行传统后正中入路手术治疗的效果,并对其疗效进行分析评价。方法:选取本院2010年1月-2015年1月收治的60例腰椎管狭窄症患者作为此次研究对象,患者在入院后均进行过临床影像学检查,已被确诊为腰椎管狭窄症,并且能够接受对其使用传统后正中入路手术,记录其手术结果。结果:腰椎管狭窄症患者实行传统后正中入路手术后,手术切口长度为(14.2±2.4)cm,术中出血量为(302.4±42.2)m L,术后引流量为(126.1±54.1)m L,手术时间为(145.3±25.1)min。其术前的腰痛VSA评分为(7.4±1.2)分,腿痛VSA评分为(8.2±0.9)分,腰椎ODI指数为(49.1±4.1)%;术后3个月的腰痛VSA评分为(4.9±1.3)分,腿痛VSA评分为(1.8±0.4)分,腰椎ODI指数为(39.2±3.5),末次随访的腰痛VSA评分为(2.8±0.9)分,腿痛VSA评分为(1.3±0.5)分,腰椎ODI指数为(24.2±6.4)%。末次随访各项指标明显优于术后,术后各项指标明显优于术前,比较差异均有统计学意义(P<0.05)。结论:为患有腰椎管狭窄症的患者实行传统后正中入路手术能够明显控制患者病情,改善腰椎管狭窄症对患者的影响,避免此类病症对患者的伤害,降低患者的术前、术后3个月、末次随访的腰痛VSA评分和腿痛VSA评分,同时降低患者的腰椎ODI指数,为患者病情治疗提供了有效手术价值经验,值得在临床上推广。
Objective:To observe and analyze the efficacy of traditional posterior midline approach in the treatment of lumbar spinal stenosis disease.Method:60 patients with lumbar spinal stenosis disease as the research objects were selected in our hospital from January 2010 to January 2015,they were given traditional posterior midline approach surgery treatment, its surgery results were recorded.Result:Lumbar spinal stenosis disease patients in the treatment of traditional posterior midline approach surgery,surgical incision of length was(14.2±2.4)cm,intraoperative blood loss was(302.4±42.2)m L,postoperation volume of drainage was(126.1±54.1)m L,operative time was(145.3±25.1)min.Preoperative lumbago VSA score was(7.4±1.2)score,leg pain for VSA score was(8.2±0.9)score,lumbar ODI was(49.1±4.1)%;postoperative 3 monthes lumbago VSA score was(4.9±1.3)score,leg pain for VSA score was(1.8±0.4)score,lumbar ODI was(39.2±3.5)%;the last follow-up for lumbago VSA score was(2.8±0.9)score,leg pain for VSA score was(1.3±0.5)score,lumbar ODI was(24.2±6.4)%.At the end of the follow-up of each index was better than preoperative,each index was better than preoperative,the differences were statistically significant(P<0.05).Conclusion:For patients with lumbar spinal stenosis disease after practice the traditional surgery patients can significantly control center into the road, lower back pain in patients with VSA score and the leg pain VSA score, at the same time, patients with lower lumbar ODI index, experience provides effective treatment for the patient,it is worth to strengthen and promote in clinic.
Objective:To observe and analyze the efficacy of traditional posterior midline approach in the treatment of lumbar spinal stenosis disease.Method:60 patients with lumbar spinal stenosis disease as the research objects were selected in our hospital from January 2010 to January 2015,they were given traditional posterior midline approach surgery treatment, its surgery results were recorded.Result:Lumbar spinal stenosis disease patients in the treatment of traditional posterior midline approach surgery,surgical incision of length was(14.2±2.4)cm,intraoperative blood loss was(302.4±42.2)m L,postoperation volume of drainage was(126.1±54.1)m L,operative time was(145.3±25.1)min.Preoperative lumbago VSA score was(7.4±1.2)score,leg pain for VSA score was(8.2±0.9)score,lumbar ODI was(49.1±4.1)%;postoperative 3 monthes lumbago VSA score was(4.9±1.3)score,leg pain for VSA score was(1.8±0.4)score,lumbar ODI was(39.2±3.5)%;the last follow-up for lumbago VSA score was(2.8±0.9)score,leg pain for VSA score was(1.3±0.5)score,lumbar ODI was(24.2±6.4)%.At the end of the follow-up of each index was better than preoperative,each index was better than preoperative,the differences were statistically significant(P<0.05).Conclusion:For patients with lumbar spinal stenosis disease after practice the traditional surgery patients can significantly control center into the road, lower back pain in patients with VSA score and the leg pain VSA score, at the same time, patients with lower lumbar ODI index, experience provides effective treatment for the patient,it is worth to strengthen and promote in clinic.
引文
[1]刘强,李义强,梅浩,等.前、后入路手术治疗胸腰椎结核效果分析[J].吉林医学,2015,36(8):1542-1543.
[2]Mitsuyama T,Kubota M,Yuzurihara M,et al.The pitfalls in surgical management of lumbar canal stenosis associated with rheumatoid arthritis[J].Neurologia Medico-chirurgica,2013,53(12):853-860.
[3]张耀印,李涛.微创Wiltse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效分析[J].北京医学,2015,37(10):952-955.
[4]Pivec R,Johnson A J,Naziri Q,et al.Lumbar spinal stenosis impairs function following total knee arthroplasty[J].Journal of Knee Surgery,2012,26(1):59-64.
[5]严清理,张本其,桂春生,等.传统后正中入路与Wiltse入路治疗胸腰段骨折的比较[J].脊柱外科杂志,2014,5(4):231-234.
[6]Ruizespa?a S,Arana E,Moratal D.Semiautomatic computeraided classification of degenerative lumbar spine disease in magnetic resonance imaging[J].Computers in Biology and Medicine,2015,15(62):196-205.
[7]Schizas C,Pralong E,Tzioupis C,et al.Interspinous distraction in lumbar spinal stenosis:A neurophysiological perspective[J].Spine,2013,38(24):2113-2117.
[8]谢恩,郝定均,吕向伟,等.腰椎管狭窄症术后出现转换性障碍一例报告[J].中华骨科杂志,2012,32(1):92-93.
[9]Kim C H,Chung C K,Park C S,et al.Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis:Anationwide cohort study[J].Spine J,2013,13(10):1230-1237.
[10]林定坤,陈树东,苏国义,等.经肌间隙入路经椎间孔腰椎椎体间融合术并椎管潜行减压治疗腰椎管狭窄症[J].广东医学,2013,34(15):2336-2339.
[11]Zhang C,Xue Y,Wang P,et al.Foot Drop Caused by SingleLevel Disc Protrusion between T10 and L1[J].Spine,2013,38(26):2295-2301.
[12]孙华峰,王文斌,王永久,等.后路椎间盘镜治疗老年腰椎管狭窄症中的应用及相关影响因素研究[J].重庆医学,2013,42(35):4257-4259.
[13]Resnick D K,Rd W W,Sharan A,et al.Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 10:Lumbar fusion for stenosis without spondylolisthesis[J].Journal of Neurosurgery Spine,2014,21(1):62-66.
[14]谢静波,伍俐亭,鄢义云,等.小切口经肌间隙入路治疗腰椎管狭窄症的临床观察[J].中国医学创新,2015,12(34):32-35.
[15]金新蒙,刘杰,吕枫,等.脊髓型颈椎病合并腰椎管狭窄症的诊断和治疗策略[J].中华骨与关节外科杂志,2016,9(2):114-117.
[16]Lin J H,Chiang Y H,Chen C C.Research Strategies for Pain in Lumbar Radiculopathy Focusing on Acid-Sensing Ion Channels and Their Toxins[J].Current Topics in Medicinal Chemistry,2015,15(7):617-630.
[17]李富明,谢湘涛,韦钊岚,等.选择性开窗减压术治疗70岁以上老年人多节段腰椎管狭窄症的疗效分析[J].微创医学,2013,8(2):167-168,204.
[18]Menon V K,Raniga S B,Al Busaidi A Q.MRI Morphology of Surgically Treated Lumbar Canal Stenosis A Retrospective Study[J].Journal of Spinal Disorders Techniques,2015,28(1):12-18.
[19]朱迪,李危石,陈仲强,等.腰椎管狭窄症减压固定融合术后远期疗效及其影响因素分析[J].中国脊柱脊髓杂志,2013,23(10):865-871.
[20]Kamita M,Mori T,Sakai Y,et al.Proteomic analysis of ligamentum flavum from patients with lumbar spinal stenosis[J].Proteomics,2015,15(9):1622-1630.
[21]Chen H,Kelling J.Mild Procedure for Lumbar Decompression:A Review[J].Pain Practice:the Official Journal of World Institute of Pain,2013,13(2):146-153.
[22]林加阳,李钿,徐耿填,等.经椎旁肌间隙入路在胸腰椎骨折患者临床治疗中的应用及疗效分析[J].中国医学创新,2015,12(3):121-123.
[23]Adogwa O,Owens R,Karikari I,et al.Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis,adjacentsegment disease,or same-level recurrent stenosis.Part 2.A costeffectiveness analysis;Clinical article[J].Journal of Neurosurgery Spine,2013,18(2):147-153.
[24]阮腊林.肌间隙入路伤椎置钉治疗胸腰椎骨折的疗效分析[J].中国医学创新,2015,12(29):117-119.
[25]罗庆明,黄福才,魏林平,等.山区县医院经椎旁肌间隙入路治疗胸腰椎骨折的应用[J].中国医学创新,2016,13(13):129-133.
[2]Mitsuyama T,Kubota M,Yuzurihara M,et al.The pitfalls in surgical management of lumbar canal stenosis associated with rheumatoid arthritis[J].Neurologia Medico-chirurgica,2013,53(12):853-860.
[3]张耀印,李涛.微创Wiltse入路与传统后正中入路手术治疗双节段腰椎管狭窄症的疗效分析[J].北京医学,2015,37(10):952-955.
[4]Pivec R,Johnson A J,Naziri Q,et al.Lumbar spinal stenosis impairs function following total knee arthroplasty[J].Journal of Knee Surgery,2012,26(1):59-64.
[5]严清理,张本其,桂春生,等.传统后正中入路与Wiltse入路治疗胸腰段骨折的比较[J].脊柱外科杂志,2014,5(4):231-234.
[6]Ruizespa?a S,Arana E,Moratal D.Semiautomatic computeraided classification of degenerative lumbar spine disease in magnetic resonance imaging[J].Computers in Biology and Medicine,2015,15(62):196-205.
[7]Schizas C,Pralong E,Tzioupis C,et al.Interspinous distraction in lumbar spinal stenosis:A neurophysiological perspective[J].Spine,2013,38(24):2113-2117.
[8]谢恩,郝定均,吕向伟,等.腰椎管狭窄症术后出现转换性障碍一例报告[J].中华骨科杂志,2012,32(1):92-93.
[9]Kim C H,Chung C K,Park C S,et al.Reoperation rate after surgery for lumbar spinal stenosis without spondylolisthesis:Anationwide cohort study[J].Spine J,2013,13(10):1230-1237.
[10]林定坤,陈树东,苏国义,等.经肌间隙入路经椎间孔腰椎椎体间融合术并椎管潜行减压治疗腰椎管狭窄症[J].广东医学,2013,34(15):2336-2339.
[11]Zhang C,Xue Y,Wang P,et al.Foot Drop Caused by SingleLevel Disc Protrusion between T10 and L1[J].Spine,2013,38(26):2295-2301.
[12]孙华峰,王文斌,王永久,等.后路椎间盘镜治疗老年腰椎管狭窄症中的应用及相关影响因素研究[J].重庆医学,2013,42(35):4257-4259.
[13]Resnick D K,Rd W W,Sharan A,et al.Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine.Part 10:Lumbar fusion for stenosis without spondylolisthesis[J].Journal of Neurosurgery Spine,2014,21(1):62-66.
[14]谢静波,伍俐亭,鄢义云,等.小切口经肌间隙入路治疗腰椎管狭窄症的临床观察[J].中国医学创新,2015,12(34):32-35.
[15]金新蒙,刘杰,吕枫,等.脊髓型颈椎病合并腰椎管狭窄症的诊断和治疗策略[J].中华骨与关节外科杂志,2016,9(2):114-117.
[16]Lin J H,Chiang Y H,Chen C C.Research Strategies for Pain in Lumbar Radiculopathy Focusing on Acid-Sensing Ion Channels and Their Toxins[J].Current Topics in Medicinal Chemistry,2015,15(7):617-630.
[17]李富明,谢湘涛,韦钊岚,等.选择性开窗减压术治疗70岁以上老年人多节段腰椎管狭窄症的疗效分析[J].微创医学,2013,8(2):167-168,204.
[18]Menon V K,Raniga S B,Al Busaidi A Q.MRI Morphology of Surgically Treated Lumbar Canal Stenosis A Retrospective Study[J].Journal of Spinal Disorders Techniques,2015,28(1):12-18.
[19]朱迪,李危石,陈仲强,等.腰椎管狭窄症减压固定融合术后远期疗效及其影响因素分析[J].中国脊柱脊髓杂志,2013,23(10):865-871.
[20]Kamita M,Mori T,Sakai Y,et al.Proteomic analysis of ligamentum flavum from patients with lumbar spinal stenosis[J].Proteomics,2015,15(9):1622-1630.
[21]Chen H,Kelling J.Mild Procedure for Lumbar Decompression:A Review[J].Pain Practice:the Official Journal of World Institute of Pain,2013,13(2):146-153.
[22]林加阳,李钿,徐耿填,等.经椎旁肌间隙入路在胸腰椎骨折患者临床治疗中的应用及疗效分析[J].中国医学创新,2015,12(3):121-123.
[23]Adogwa O,Owens R,Karikari I,et al.Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis,adjacentsegment disease,or same-level recurrent stenosis.Part 2.A costeffectiveness analysis;Clinical article[J].Journal of Neurosurgery Spine,2013,18(2):147-153.
[24]阮腊林.肌间隙入路伤椎置钉治疗胸腰椎骨折的疗效分析[J].中国医学创新,2015,12(29):117-119.
[25]罗庆明,黄福才,魏林平,等.山区县医院经椎旁肌间隙入路治疗胸腰椎骨折的应用[J].中国医学创新,2016,13(13):129-133.