文章摘要
林海滨,许子星,戴建辉.显微椎间盘镜下黄韧带不同干预方式的结果分析[J].南京医科大学学报,2008,28(4):545~549
显微椎间盘镜下黄韧带不同干预方式的结果分析
Comparison of the follow-up results in different interventions for flavum ligament operation during microendoscopic discectomy
投稿时间:2007-10-20  
DOI:10.7655
中文关键词: 显微椎间盘镜  硬膜外粘连  黄韧带
英文关键词: MED  epidural fibrosis  flavum ligament
基金项目:
作者单位
林海滨 莆田学院附属医院骨科福建 莆田 351100 
许子星  
戴建辉  
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中文摘要:
      目的:探讨显微椎间盘镜下黄韧带的不同干预方式对临床疗效和随访CT图象的影响。方法:92例患者随机分为2组,A组进行常规显微椎间盘镜下髓核摘除术,B组保留黄韧带行髓核摘除术。分别于术前1天、术后3周、3个月、1年进行资料采集。采用Oswestry功能障碍指数(ODI)进行疗效评估,计算改善率。术后1年对随访CT图象进行粘连程度分级,两组间不同粘连级别的人数进行构成比分析,对所有患者的CT分级与其术后1年改善率进行相关性分析。结果:术前1天ODI均数及术后3周改善率比较均未见显著性差异(P > 0.05)。术后3个月及术后1年,改善率两组间比较均有极其显著的差异(P < 0.001)。A组改善率术后3个月较术后3周略有提高(P > 0.05),术后1年出现下降(P < 0.05),术后1年与术后3周改善率比较无显著性差异(P > 0.05);B组改善率总体上呈持续提高趋势,术后3周与术后3个月改善率比较无显著性差异(P > 0.05),术后1年与术后3个月、术后1年与术后3周改善率比较可见显著性差异(P < 0.05)。术后1年CT分级,两组间各分级人数构成具有显著性差异(P < 0.05)。各患者CT分级及其改善率的相关性分析,结果显示存在极其显著的差异(P < 0.01)。结论:对黄韧带的不同干预方式能够明显影响术后CT表现出来的椎管内瘢痕粘连的程度差异。椎管内粘连程度与临床疗效呈显著的负相关,即椎管内粘连程度越重,相应的临床疗效越低。
英文摘要:
      Objective:To evaluate the effects of different interventions for flavum ligament in clinical results and CT outcomes on microendoscopic discectomy(MED). Methods:Ninety-two patients were divided into two groups at random. Both groups were disposed with microendoscopic discectomy,differentiated from each other by flavum ligament operation. Data at 1 day pre-operation,3 weeks,3 months and 1 year post-operation were followed up,respectively. The clinical effects were assessed by Oswestry Disability Index,and the improvement rates were also calculate. CT films taken from 1 year follow-up were graded,and the constitution of different graded cases were analyzed between 2 groups. The Correlation between graded CT films and corresponding improvement rates were analyzed. Results:Both ODI at 1 day pre-operation and improvement rates at 3 weeks post-operation were observed no significant difference(P > 0.05). At 3 months and 1 year post-operation,the improvement rates between two groups had significant difference(P < 0.001). In group A,the improvement rates increased at 3 months post-operation in contrast to 3 weeks post-operation(P > 0.05),which declined 1 year later(P < 0.05). No significant difference between 3 weeks and 1 year post-operation was observed(P > 0.05). In group B,the improvement rates increase continually. There was no significant difference(P > 0.05) between 3 weeks and 3 months post-operation,whereas significant differences were observed between 1 year and 3 months,1 year and 3 weeks(P < 0.05). At 1 year post-operation,the constitution of different graded CT films between two groups had significant difference(P < 0.05). Correlative analysis revealed obvious difference between each graded CT and corresponding improvement rate(P < 0.01). Conclusion:Different interventions for flavum ligament can obviously affect the variances of epidural fibrosis that CT films manifested. There was a negative correlation between fibrosis degrees and clinical effects.
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