【作者】 何克云；

【导师】 李志忠；

【作者基本信息】 暨南大学 ， 骨外科， 2010， 硕士

【摘要】 目的：通过对后路腰椎融合内固定手术前后X线片选定指标的测量,客观评价手术特点及早期对腰椎大体结构和生理功能的影响。并结合手术疗效,分析腰椎大体结构的变化与疗效是否具有相关性,以对手术方法做出客观的评价,完善手术方式及术后处理事项。方法：搜集经后路行L4/5椎间盘摘除、椎间植骨融合、椎弓根钉内固定手术(以下简称PLIF术)的病人40例,男19例,女21例,年龄范围42-72岁。单纯L4/5椎间盘突出并椎管狭窄症28例,L4滑脱12例。随访时间6-24个月,分别测量各患者术前及术后1-2年的腰椎相关指数,包括腰椎前凸角度、腰骶角、骶骨倾斜角、L3/4椎间隙高度。随访其手术疗效,统计术前及术后随访时的指标变化,分析与疗效的关系,并用SPSSI3.0统计软件作相关性统计分析。结果：L4/5腰椎间盘突出并椎管狭窄症或者腰椎滑脱行后路减压植骨融合内固定手术,两年内优良率为95%,对腰椎侧位片测量数据进行统计学分析,其结果如下：(1)术后腰椎前凸角度、骶骨倾斜角较术前增大(P<0.05),L3/4椎间隙高度减小(P<0.05),腰骶角改变无统计学意义(P>0.05)。(2)腰椎间盘突出症组与腰椎滑脱组,腰骶角手术间后的改变有差别(P<0.05),腰椎间盘突出症组腰骶角术后增大,腰椎滑脱组术后腰骶角减小。腰椎前凸角度、骶骨倾斜角、L3/4椎间隙高度手术前后的改变均无统计学意义(P>0.05)。(3)术后一年内与术后两年内腰椎前凸角度、骶骨倾斜角、腰骶角、L3/4椎间隙高度改变均无统计学意义(P>0.05)。(4)患者术后两年内的自觉腰腿痛症状与手术前后腰椎前凸角度、骶骨倾斜角、腰骶角、L3/4椎间隙高度的改变无直接关系(P>0.05)(5)腰椎间盘突出症组与腰椎滑脱组病人术前的腰椎前凸角度、骶骨倾斜角、腰骶角、L3/4椎间隙高度的差别均无统计学意义(P>0.05)。(6)腰椎间盘突出症组与腰椎滑脱组病人术后的腰椎前凸角度、骶骨倾斜角差别无统计学意义(P>0.05)；腰骶角、椎间隙高度差别有统计学意义(P<0.05),腰椎间盘突出症组病人术后腰骶角和椎间隙高度值均大于腰椎滑脱组。结论：PLIF手术是治疗腰椎间盘突出并椎管狭窄症及腰椎滑脱症的有效手术治疗方法之一。(1)手术使病人的腰椎前凸角度、骶骨倾斜角均得以改善,恢复腰椎的功能活动。(2)L4-5PLIF手术后可导致其邻近上一节段椎间隙降低,说明导致邻近节段的退变。(3)L4-5PLIF手术后两年内其邻近下一阶段退变不明显。(4)患者术后两年内残余的腰腿痛症状与分析的腰椎前凸角度、骶骨倾斜角、腰骶角及椎间隙高度均无直接相关性。更多还原

【Abstract】 Objective:The thesis aims to give an objective evaluation of the characteristic of posterior lumbar interbody fusion internal fixation and the influence of operation to the construction and function of lumbar through measuring the selected indexes of Pro and Post operation X-ray. Furthermore, the relation between general lumbar structure variation and curative effect will be analyzed based on the actual curative effect. The purpose of the research is to evaluate objectively the curative effect of lumbar operations and to improve the surgical procedure and postoperative management issues.Methods:Cases of 40 patients who had experienced L4/5 disc removal, intervertebral bone graft fusion and posterior lumbar interbody fusion internal fixation were collected for study. There are 19 male and 21 female patients aged from 42 to 72, of which 28 cases of L4/5lumbar intervertebral disc herniation and spinal stenosis,12 cases of lumbar spondylolisthesis. The following-up period is 12 to 24 months after operation, during which the lumbar correlation indexes was recorded, including the ante-protruding index, sacrum slant angle, lumbosacral angle and L3/4 intervertebral space altitude etc. The relation between the curative effect and the correlation indexes is studied according to the follow-up investigation. Statistics are collected and analyzed by image processing system and SPSS 13.0 statistical software.Results:Posterior lumbar interbody fusion in treatment of L4/5 lumbar disc herniation and spinal stenosis or lumbar spondylolisthesis, the excellent rate was 95% in two years. Analyses statistically the measuring data of lumbar side position piece, As a result:1. After operation, lumbar lordotic angle,sacral slope angles were improved(P< 0.05), L3/4 intervertebral space altitude decreased(P<0.05), lumbosacral angle showed no significant differences (P>0.05) resulted from the operation.2. By testing, the lumbosacral angle of the group of lumbar disc herniation and spinal stenosis and the group of lumbar spondylolisthesis was found different after the surgery (P<0.05).In group of lumbar disc herniation and spinal stenosis, lumbosacral angle increased; in group of lumbar spondylolisthesis, lumbosacral angle decreased. Lumbar lordotic angle, sacral slope angles, L3/4 intervertebral space altitude showed no nificant differences before and after the operation (P>0.05)3.1 or 2 years after the operation, lumbar lordotic angle, sacral slope angles, lumbosacral angle, L3/4 intervertebral space altitude showed no significant difference (P>0.05)4. In the two years of postoperation,the painful symptom of the patient is not directly connected to the change of the space altitude of lumbar lordotic angle, sacral slope angles, lumbosacral angle, L3/4 intervertebral after the operation (P >0.05)5. The space altitude of lumbar lordotic angle, sacral slope angles, lumbosacral angle and L3/4 intervertebral showed no significant differences before the operation in the group of lumbar disc herniation and spinal stenosis and the group of lumbar spondylolisthesis (P>0.05)6. After the surgery, lumbar lordotic angle, sacral slope angles showed no significant differences in the group of lumbar disc herniation and spinal stenosis. In the group of lumbar spondylolisthesis (P>0.05), the space altitude of lumbosacral angle, L3/4 intervertebral have changed (P<0.05).In the group of lumbar disc herniation and spinal stenosis, the space altitude of lumbosacral angle and L3/4 intervertebral is greater than the group of lumbar spondylolisthesis after the operation.Conclusion:PLIF operation is one of the efficient methods to treat the L4/5 lumbar disc herniation and spinal stenosis or lumbar spondylolisthesis.1. The operation can improve the lumbar lordotic angle and sacral slope angles, and the function of lumbar spine can recover.2. The L4-5 PILF operation can narrow the space with the upper adjacent segment, from which the conclusion can be drawn that PILF operation leads to ASD of the upper adjacent segment.3. The ASD of the lower adjacent segment is not obvious within the two years after the L4-5 PLIF operation.4. In the two years of postopration,the follow-up result showed that remnant symptom has no direct correlation with the intervertebral space altitude of lumbar lordotic angle, sacral slope angles, lumbosacral angle and L3/4.更多还原