摘要
目的探讨多节段腰椎间盘突出症精准治疗的临床疗效。方法通过对2011年10月至2015年10月入选的78例多节段腰椎间盘突出症患者的临床资料进行回顾性分析,应用X线片、腰椎CT及三维重建、腰椎MRI、双下肢肌电图并综合患者的临床症状、体征,明确责任椎间隙及神经受压部位。所有患者均确诊为多节段椎间盘突出,并进行精确减压,对于合并腰椎不稳者予以单节段椎间融合内固定。术后参考腰腿痛目测类比评分系统(VAS)和日本骨科协会评分系统(JOA)对患者的临床恢复情况进行评估。结果所有患者均手术顺利,获得6~24个月随访,末次随访患者的VAS评分和JOA评分均较术前有明显改善,其中VAS评分改善率为79%,JOA评分改善率为91%。所有患者均得到良好的恢复锻炼,且无内固定松动、断裂或畸形,无腰椎矢状位失衡,无临椎退变,无感染等严重并发症的发生。结论术前根据患者具体病史和影像学检测,科学、有效地确定责任椎间隙及神经受压部位,并合理运用单节段椎弓根固定联合椎间融合,对责任椎间隙进行减压、融合、固定,可以有效治疗多节段腰椎间盘突出症,帮助患者有效地改善腰椎稳定性,减轻症状,为临床上治疗多节段腰椎间盘突出症提供一定的临床经验。
Objective To investigate the clinical effects of precise treatment on multi-segmental lumbar disc herniation.Methods The clinical data of 78 cases with multi-stage lumbar disc herniation from October 2011 to October 2015 were retrospectively analyzed, and we identified the corresponding segment and the area of nerve compression by X-ray, CT scan and 3-D reconstruction, MRI and EMG.All patients were diagnosed as multi-segmental lumbar disc herniation, and took treatment of posterior discectomy.And the patients with lumbar spinal instability were treat by PILF or TILI.The clinical recovery of postoperative patients according to low back pain visual analog scale reference systems （VAS） and the Japanese Orthopaedic Association scoring system （JOA） were evaluated.Results All patients＇ surgery were successfully done and had received a 6 to 24 months follow-up.The VAS score and JOA scores of the end of the follow-up had significantly improved, and the VAS score improvement rate was 79%, JOA score improvement rate was 91%.All patients got a good workout recovery, and with no internal fixation loosening, fracture or deformity, lumbar sagittal imbalance, no adjacent segment degeneration, no infection and other serious complications.Conclusion According to preoperative patient-specific medical history and radiological detection, we can clear the corresponding segment and the area of nerve compression scientifically and effectively.We can effectively improve the stability of the lumbar spine, reduce symptoms by decompressing, fusing and fixing corresponding segment with single-segment pedicle fixation and interbody fusion.This method provide some clinical experience to treat multiple segmental lumbar disc herniation.
出处
《临床医学》
CAS
2017年第6期29-31,共3页
Clinical Medicine
关键词
精准治疗
责任椎间隙
椎间融合
腰椎间盘突出
Precise threatment
Corresponding segment
Interbody fusion
Lumbar disc herniation
