84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]楊廣輝,潘玉林,郭小偉,等.后正中入路聯(lián)合Wiltse入路治療腰椎間盤突出癥合并腰椎失穩(wěn)的臨床療效[J].中醫(yī)正骨,2020,32(08):17-23.
　YANG Guanghui,PAN Yulin,GUO Xiaowei,et al.Clinical curative effects of surgery through posterior median approach combined with Wiltse approach for treatment of lumbar disc herniation with lumbar instability[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(08):17-23.
點擊復制

后正中入路聯(lián)合Wiltse入路治療腰椎間盤突出癥合并腰椎失穩(wěn)的臨床療效()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年08期
頁碼:
17-23
欄目:
臨床研究
出版日期:
2020-08-20

文章信息/Info

Title:
Clinical curative effects of surgery through posterior median approach combined with Wiltse approach for treatment of lumbar disc herniation with lumbar instability
作者:
楊廣輝; 潘玉林; 郭小偉; 張懷栓; 張猛; 李寶田; 楊柳
(鄭州市骨科醫(yī)院,河南 鄭州 450052)
Author(s):
YANG Guanghui; PAN Yulin; GUO Xiaowei; ZHANG Huaishuan; ZHANG Meng; LI Baotian; YANG Liu
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  腰椎失穩(wěn);  椎旁肌;  手術(shù)入路;  脊柱融合術(shù);  椎弓根釘;  臨床試驗
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  lumbar instability;  paraspinal muscle;  operative approach;  spinal fusion;  pedicle screws;  clinical trial
摘要:
目的:探討后正中入路聯(lián)合Wiltse入路治療腰椎間盤突出癥合并腰椎失穩(wěn)的臨床療效。方法:回顧性分析接受椎弓根釘棒系統(tǒng)內(nèi)固定聯(lián)合改良經(jīng)椎間孔減壓椎間植骨融合術(shù)治療的61例腰椎間盤突出癥合并腰椎失穩(wěn)患者的病例資料,其中采用后正中入路聯(lián)合Wiltse入路28例、后正中入路33例。男32例,女29例。年齡(53.36±16.24)歲。病變部位,L3～45例、L4～536例、L5S120例。比較2組患者手術(shù)時間、術(shù)中出血量和術(shù)后引流量,分別比較術(shù)前、術(shù)后12個月2組患者的腰腿部疼痛視覺模擬量表(visual analogue scale,VAS)評分和Oswestry功能障礙指數(shù)(Oswestry disability index,ODI),并分別比較術(shù)前和末次隨訪時2組患者的腰椎凹陷值。結(jié)果:①一般指標。61例患者椎間隙植骨均獲得骨性融合,其中52例術(shù)后3個月獲得骨性融合、9例術(shù)后6個月獲得骨性融合。2組患者手術(shù)時間比較,差異無統(tǒng)計學意義[(115±12)min,(119±10)min,t=-1.526,P=0.132]; 后正中入路聯(lián)合Wiltse入路組術(shù)中出血量和術(shù)后引流量均小于后正中入路組[(161±27)mL,(343±44)mL,t=-19.003,P=0.000;(161±35)mL,(350±63)mL,t=-14.709,P=0.000]。②腰部疼痛VAS評分。術(shù)前2組患者腰部疼痛VAS評分比較,差異無統(tǒng)計學意義[(7.1±1.0)分,(7.0±1.1)分,t=0.398,P=0.692]; 術(shù)后12個月,后正中入路聯(lián)合Wiltse入路組腰部疼痛VAS評分低于后正中入路組[(1.6±0.7)分,(2.8±1.1)分,t=-4.749,P=0.000],2組患者腰部疼痛VAS評分均低于術(shù)前(t=25.409,P=0.000; t=14.978,P=0.000)。③腿部疼痛VAS評分。術(shù)前和術(shù)后12個月,2組患者腿部疼痛VAS評分比較,差異均無統(tǒng)計學意義[(7.5±0.7)分,(7.6±0.8)分,t=-0.674,P=0.503;(1.4±0.4)分,(1.4±0.5)分,t=0.231,P=0.651]; 術(shù)后12個月,2組患者腿部疼痛VAS評分均低于術(shù)前(t=38.853,P=0.000; t=33.719,P=0.000)。④ODI。術(shù)前2組患者ODI比較,差異無統(tǒng)計學意義[(81.86±5.55)%,(83.21±5.92)%,t=-0.917,P=0.698]; 術(shù)后12個月,后正中入路聯(lián)合Wiltse入路組ODI低于后正中入路組[(30.36±4.99)%,(43.82±7.83)%,t=-7.839,P=0.000],2組患者ODI均低于術(shù)前(t=37.354,P=0.000; t=21.891,P=0.000)。⑤腰椎凹陷值。術(shù)前2組患者腰椎凹陷值比較,差異無統(tǒng)計學意義[(12.2±1.9)mm,(12.8±1.9)mm,t=-0.174,P=0.862]; 末次隨訪時,后正中入路聯(lián)合Wiltse入路組腰椎凹陷值大于后正中入路組[(11.6±1.7)mm,(10.0±2.0)mm,t=3.305,P=0.002],2組患者腰椎凹陷值均低于術(shù)前(t=9.065,P=0.000; t=18.101,P=0.000)。結(jié)論:后正中入路聯(lián)合Wiltse入路治療腰椎間盤突出癥合并腰椎失穩(wěn),損傷小,能夠緩解腰腿部疼痛,促進腰椎功能的恢復,有效保護一側(cè)椎旁肌。
Abstract:
To explore the clinical curative effects of surgery through posterior median approach combined with Wiltse approach for treatment of lumbar disc herniation(LDH)with lumbar instability.Methods:The medical records of 61 patients who received pedicle screw-rod system internal fixation combined with modified transforaminal decompression and intervertebral bone graft fusion for treatment of LDH and lumbar instability were analyzed retrospectively.Twenty-eight patients were treated through posterior median approach combined with Wiltse approach(group A),and the others were merely treated through posterior median approach(group B).The patients consisted of 32 males and 29 females and ranged in age of 53.36+/-16.24 years.The pathological changes located at L3-4(5),L4-5(36)and L5S1(20).The operative time,intraoperative blood loss and postoperative drainage volume were compared between the 2 groups.The lumbago-leg pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)obtained before the surgery and at 12 months after the surgery and the lumbar indentation values obtained before the surgery and at last follow-up were compared between the

參考文獻/References:

[1] CHO S M,KIM S H,HA S K,et al.Paraspinal muscle changes after single-level posterior lumbar fusion:volumetric analyses and literature review[J].BMC Musculoskelet Disord,2020,21(1):73.
[2] 康永奇,李豪,蒲君濤.經(jīng)皮椎間孔鏡髓核摘除術(shù)治療極外側(cè)型腰椎間盤突出癥[J].中醫(yī)正骨,2019,31(7):72-74.
[3] 孫德舜,李慶斌,蘇佰芳,等.經(jīng)皮椎間孔鏡技術(shù)在腰椎間盤突出癥治療中的應用進展[J].中醫(yī)正骨,2015,27(6):29-32.
[4] 陳根連,陳毅.椎間孔鏡技術(shù)治療腰椎間盤突出癥[J].中醫(yī)正骨,2020,32(3):74-76.
[5] 劉相英,劉建軍,李士民.脊柱內(nèi)鏡全可視技術(shù)治療腰椎間盤突出癥[J].中醫(yī)正骨,2019,31(7):69-71.
[6] CHEN Y C,ZHANG L,LI E N,et al.An updated meta-analysis of clinical outcomes comparing minimally invasive with open transforaminal lumbar interbody fusion in patients with degenerative lumbar diseases[J].Medicine(Baltimore),2019,98(43):e17420.
[7] KIM W J,LEE J W,KIM S M,et al.Precautions for combined anterior and posterior long-level fusion for adult spinal deformity:perioperative surgical complications related to the anterior procedure(oblique lumbar interbody fusion)[J].Asian Spine J,2019,13(5):823-831.
[8] WEINSTEIN P,CAMERON A S.A houseboat outbreak of epidemic polyarthritis[J].Med J Aust,1991,155(10):721-722.
中醫(yī)正骨2020年8月第32卷第8期 J Trad Chin Orthop Trauma,2020,Vol.32,No.8(總583)
(總584)中醫(yī)正骨2020年8月第32卷第8期 J Trad Chin Orthop Trauma,2020,Vol.32,No.8
[9] 張蒂,馮世慶.斜外側(cè)腰椎椎間融合術(shù)[J].中華骨科雜志,2017,37(16):1029-1035.
[10] WANG Y,ZHANG Y Q,CHONG F L,et al.Clinical outcomes of minimally invasive transforaminal lumbar interbody fusion via a novel tubular retractor[J].J Int Med Res,2020,48(5):300060520920090.
[11] 蔣協(xié)遠,王大偉.骨科臨床療效評價標準[M].北京:人民衛(wèi)生出版社,2005.
[12] TAKAYAMA K,KITA T,NAKAMURA H,et al.New Predictive index for lumbar paraspinal muscle degeneration associated with aging[J].Spine(Phila Pa 1976),2016,41(2):E84-90.
[13] WILTSE L L,BATEMAN J G,HUTCHINSON R H,et al.The paraspinal sacrospinalis-splitting approach to the lumbar spine[J].J Bone Joint Surg Am,1968,50(5):919-926.
[14] WILTSE L L,SPENCER C W.New uses and refinements of the paraspinal approach to the lumbar spine[J].Spine(Phila Pa 1976),1988,13(6):696-706.
[15] HOH D J,WANG M Y,RITLAND S L.Anatomic features of the paramedian muscle-splitting approaches to the lumbar spine[J].Neurosurgery,2010,66(3 Suppl Operative):13-25.
[16] DU J Y,KIELY P D,BOGNER E,et al.Early clinical and radiological results of unilateral posterior pedicle instrumentation through a Wiltse approach with lateral lumbar interbody fusion[J].J Spine Surg,2017,3(3):338-348.
[17] 王世棟,鄧雪飛,尹宗生,等.腰椎后路椎旁肌間隙入路的解剖學與影像學觀察[J].中國脊柱脊髓雜志,2013,23(3):257-262.
[18] KATO M,KONISHI S,MATSUMURA A,et al.Clinical characteristics of intraspinal facet cysts following microsurgical bilateral decompression via a unilateral approach for treatment of degenerative lumbar disease[J].Eur Spine J,2013,22(8):1750-1757.
[19] SUWA H,HANAKITA J,OHSHITA N,et al.Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures[J].Neurol Med Chir(Tokyo),2000,40(3):151-155.
[20] HODGES P,HOLM A K,HANSSON T,et al.Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J].Spine(Phila Pa 1976),2006,3l(25):2926-2933.
[21] KAWAGUCHI Y,MATSUI H,GEJO R,et al.Preventive measures of back muscle injury after posterior lumbar spine surgery in rats[J].Spine(Phila Pa 1976),1998,23(21):2282-2287.
[22] STEVENS K J,SPENCINER D B,GRIFFITHS K L,et al.Comparison of minimally invasive and conventional open posterolateral lumbar fusion using magnetic resonance imaging and retraction pressure studies[J].J Spinal Disord Tech,2006,19(2):77-86.
[23] FAN S,HU Z,ZHAO F,et al.Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion:minimally invasive procedure versus conventional open approach[J].Eur Spine J,2010,19(2):316-324.
[24] JUN H S,KIM J H,AHN J H,et al.The effect of lumbar spinal muscle on spinal sagittal alignment:evaluating muscle quantity and quality[J].Neurosurgery,2016,79(6):847-855.
[25] GWAK G T,HWANG U J,JUNG S H,et al.Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration[J].BMC Musculoskelet Disord,2019,20(1):576.
[26] BERRY D B,PADWAL J,JOHNSON S,et al.Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine[J].BMC Musculoskelet Disord,2018,19(1):135.

相似文獻/References:

[1]鄧紅軍.硫酸鈣骨水泥椎體成形聯(lián)合后路短節(jié)段椎弓根螺釘 內(nèi)固定治療創(chuàng)傷性胸腰椎骨折[J].中醫(yī)正骨,2015,27(10):35.
[2]張莉,秦丹霞,張細姣.腹針治療椎間盤源性腰痛[J].中醫(yī)正骨,2015,27(10):38.
[3]吳青坡,孫國紹,王林杰.后路椎管減壓聯(lián)合腰椎椎弓根釘動態(tài)穩(wěn)定裝置內(nèi)固定 治療單節(jié)段腰椎退行性疾病[J].中醫(yī)正骨,2015,27(10):42.
[4]郭小偉,梅偉,潘玉林,等.一期后路病灶清除納米仿生骨椎體支撐體植骨融合 內(nèi)固定治療胸腰椎結(jié)核[J].中醫(yī)正骨,2015,27(07):66.
[5]孫廣江,崔海艦.絡(luò)病理論指導下應用獨活寄生湯加減治療腰椎間盤突出癥[J].中醫(yī)正骨,2015,27(12):37.
　SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(獨活寄生湯加減)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):37.
[6]阮朝陽,曾強華,朱群威.口服消栓口服液和甲鈷胺膠囊治療腰椎間盤突出癥 經(jīng)皮椎間孔鏡術(shù)后下肢殘留神經(jīng)癥狀[J].中醫(yī)正骨,2015,27(12):71.
[7]陳冠軍,陳揚,莊汝杰.可灌注骨水泥椎弓根螺釘系統(tǒng) 在老年腰椎疾患手術(shù)中的應用[J].中醫(yī)正骨,2015,27(02):40.
[8]萬宏波,馬海燕,蔣云霞,等.口服益氣化瘀湯聯(lián)合功能鍛煉治療腰椎退行性疾病 術(shù)后殘留腰腿痛的臨床研究[J].中醫(yī)正骨,2015,27(06):1.
　WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益氣化瘀湯)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):1.
[9]賀振年,康信勇,徐洪偉,等.骨盆矢狀位參數(shù)對退行性腰椎滑脫癥的影響[J].中醫(yī)正骨,2015,27(06):19.
　HE Zhennian,KANG Xinyong,XU Hongwei,et al.Effect of pelvic parameters in the sagittal plane on degenerative lumbar spondylolisthesis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):19.
[10]李鵬,徐世濤,譚磊.椎旁肌間隙入路傷椎單側(cè)植骨內(nèi)固定治療 單節(jié)段胸腰椎骨折[J].中醫(yī)正骨,2015,27(06):43.
[11]徐幫杰,楊楠,白偉杰,等.坐位定點旋轉(zhuǎn)整復法治療腰椎間盤突出癥的療效觀察[J].中醫(yī)正骨,2015,27(11):17.
　XU Bangjie,YANG Nan,BAI Weijie,et al.Observation on the curative effect of fixed-point rotational reduction in sitting position in the treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):17.
[12]白春曉,賈育松,孫旗,等.中醫(yī)藥在腰椎間盤突出癥圍手術(shù)期應用的研究進展[J].中醫(yī)正骨,2015,27(11):65.
[13]王少純,周英杰.郭維淮教授運用活血益氣通經(jīng)湯治療腰椎間盤突出癥的經(jīng)驗[J].中醫(yī)正骨,2015,27(11):75.
[14]蘇洪,張雪林.患側(cè)下肢牽引配合腰椎斜扳法治療 極外側(cè)型腰椎間盤突出癥[J].中醫(yī)正骨,2015,27(10):40.
[15]謝冬群,黃中梁,葉金麗.加強隔附子餅灸治療腎陽虛型腰椎間盤突出癥的 臨床研究[J].中醫(yī)正骨,2015,27(09):18.
　XIE Dongqun,HUANG Zhongliang,YE Jinli.Clinical study on intensive aconite root cake separated moxibustion in the treatment of kidney-yang-deficiency-type lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):18.
[16]沈海良,錢萬鋒,周驍棟.針刀松解聯(lián)合局部封閉與口服中藥治療腰椎間盤突出癥[J].中醫(yī)正骨,2015,27(09):46.
[17]王仁燦,黃炎洪,潘偉江,等.45°肩踝懸吊牽引下撞擊腰椎療法治療L5S1椎間盤突出癥[J].中醫(yī)正骨,2015,27(08):51.
[18]任博文,楊豪.口服桂葛萆薢湯加減配合功能鍛煉治療 寒濕型腰椎間盤突出癥[J].中醫(yī)正骨,2015,27(08):53.
[19]丁曉醫(yī),周子靜.射頻熱凝聯(lián)合臭氧注射治療腰椎間盤突出癥的護理[J].中醫(yī)正骨,2015,27(12):81.
[20]仇湘中,蔣盛昶,張信成,等.紅外熱成像圖在腰椎間盤突出癥證候療效評定中的應用[J].中醫(yī)正骨,2015,27(02):17.
　QIU Xiangzhong,JIANG Shengchang,ZHANG Xincheng,et al.Application of infrared thermal imaging to curative effect evaluation of SYMPTOM COMPLEX for patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):17.

備注/Memo

備注/Memo:
通訊作者:郭小偉 E-mail:[email protected]
更新日期/Last Update: 2020-08-20