上关节突磨除程度对腰椎间盘突出症行T ESSYS术后腰椎稳定性的影响分析  

Effects of upper facet removal on lumbar stability after TESSYS surgery for lumbar disc herniation

作　　者：薛大坤[1] 王晓滨[1] 顾春阳[1] XUE Da-kun;WANG Xiao-bin;GU Chun-yang(Department of Orthopedics, Huludao Central Hospital, Liaoning Province, 125000,China)

机构地区：[1]辽宁省葫芦岛市中心医院骨二科,辽宁葫芦岛125000

出　　处：《颈腰痛杂志》2019年第2期221-224,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察TESSYS技术治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效,并探讨术中上关节突磨除程度对患者术后腰椎稳定性的影响。方法选取2013-06-2016-06,于我院接受TESSYS手术的339例LDH患者,术后均行腰椎CT及三维重建,根据上关节突磨除程度将之分为三组:少量磨削组278例,中量磨削组49例,大量磨削组12例。所有患者术后随访2年以上,对比三组的临床疗效和腰椎不稳发生情况。结果三组患者术后3个月、1年和2年,VAS评分均较术前显著下降,JOA评分均显著升高(P<0.05);但中度和重度磨除组术后2年VAS评分>1年>3个月,术后2年的JOA评分<1年<3个月(P<0.05)。此外,术后1、2年,大量磨削组的VAS评分>中量磨削组>少量磨削组,大量磨削组的JOA评分<中量磨削组<少量磨削组,上述差异均有统计学意义(P<0.05)。大量磨削组的总有效率(92.1%)<中量磨削组(75.5%)<少量磨削组(50%),组间差异有统计学意义(P<0.05)。腰椎不稳发生率相比,大量磨削组(66.7%)>中量磨削组(34.7%)>少量磨削组(3.6%),差异均有统计学意义(P<0.05)。结论在TESSYS手术中进行椎间孔成形操作时,对上关节突进行轻度磨削不会对其预后造成明显影响,但随着磨削程度的增加,患者术后腰椎稳定性会逐渐下降,对其疗效也存在明显影响。Objective To observe the clinical efficacy of TESSYS in the treatment of lumbar disc herniation (LDH), and to explore the influence of the degree of upper articular facet excision on the stability of lumbar spine after surgery. Methods 339 cases of LDH were selected from June 2013 June -2016 for TESSYS surgery,lumbar CT and three-dimensional reconstruction were performed postoperatively. According to the degree of upper articular facet removal, there were three groups:278 cases in a small number of grinding groups, 49 cases in a medium grinding group and 12 cases in a large number of grinding groups. All patients were followed up for more than 2 years after surgery, and the clinical efficacy and lumbar instability of the three groups were compared. Results VAS scores were significantly lower and JOA scores were significantly higher at 3 months, 1 year and 2 years after operation in the three groups (P<0.05), but VAS scores were higher at 2 years after operation in moderate and severe abrasion group than at 1 year > 3 months, and JOA scores at 2 years after operation were lower than at 1 year < 3 months (P<0.05). In addition, the VAS score of the large grinding group was > medium grinding group > small grinding group at 1 and 2 years after operation. The JOA score of the large grinding group was lower than that of the medium grinding group and that of the small grinding group. The difference was statistically significant (P<0.05). The total effective rate of large grinding group (92.1%)< medium grinding group (75.5%)< small grinding group (50%) was statistically significant (P<0.05). Compared with the incidence of lumbar instability, there were significant differences in the incidence of lumbar instability between the large grinding group (66.7%), the medium grinding group (34.7%) and the small grinding group (3.6%)(P<0.05). Conclusion Mild abrasion of the superior articular process during TESSYS has no significant effect on the prognosis, but with the increase of the degree of abrasion, the stability of the lumba

关 键 词：腰椎间盘突出症 上关节突 腰椎不稳 TESSYS技术 

分 类 号：R581.53[医药卫生—内分泌]