目的 探究椎间孔镜下治疗腰椎间盘突出症切除黄韧带对腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度的影响。方法 选择120例腰椎间盘突出症患者,随机分为观察组与对照组各60例。观察组患者椎间孔镜术中切除部分黄韧带;对照组患者保留黄韧带。比较两组患者术后半年、1年及2年的腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度。结果 观察组术后半年、1年腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度与对照组比较(P＞0.05)。观察组术后2年与对照组比较(P＜0.05)。结论 椎间孔镜下治疗腰椎间盘突出症保留黄韧带术后腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度远期效果优于切除黄韧带。

Objective To explore the effects of ligamentum flavum resection on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space. Methods 120 patients with lumbar disc herniation were randomly divided into observation group and control group. In the observation group, part of the ligamentum flavum was excised by endoscope and in the control group, the ligamentum flavum was preserved. The lumbar lordosis angle, sacral inclination angle, lumbar curve index and intervertebral space height of the two groups were compared at 6 months, 1 year and 2 year after operation. Results At 6 months, 1 year after operation, the lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space in the observation group were compared with those in the control group(P＞0.05). 2 years after operation, the observation group was compared with the control group(P<0.05). Conclusion The long-term effect of ligamentum flavum preserving on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space is better than that of ligamentum flavum resection.

目的 探讨腰椎间盘手术护理路径对经皮椎管成型下腰椎间盘摘除手术患者腰腿功能康复效果。方法 选择2018年1月—2019年11月住院进行经皮椎管成型下腰椎间盘摘除手术患者60例,按住院时间先后分为对照组和实验组各30例,对照组患者术后按椎间盘摘除手术给患者进行病情观察、腰腿功能康复锻炼、腰围配戴和康复护理知识宣教等护理;实验组患者在实施对照组护理措施基础上按腰椎间盘手术护理路径对患者进行有计划的康复护理知识宣教,按制定的康复护理路径对患者进行个性化康复活动训练指导。术后1周和出院时分别对患者掌握康复护理训练知识、腰椎功能障碍指数(ODI)、服务满意度进行评价。结果 实验组患者在术后首次进行康复训练时间早于对照组,差异有统计学意义(P=0.000 4);掌握康复护理知识得分实验组高于对照组,差异有统计学意义(P=0.002 3);掌握康复训练活动实验组高于对照组,差异有统计学意义(P<0.05);腰椎功能障碍指数(ODI)实验组低于对照组,差异有统计学意义(P<0.05);护理服务满意度实验组高于对照组,结果差异有统计学意义(P<0.05)。结论 椎间盘手术护理路径能促进患者早期进行康复训练,提高患者对腰椎间盘术后康复护理知识和康复训练技能的掌握,降低患者腰椎功能障碍指数,促进术后患者机体功能的康复。

Objective To explore the effect of nursing path of lumbar disc operation on the rehabilitation of lumbar and leg function in patients undergoing percutaneous laminoplasty. Methods From January 2018 to November 2019, 60 patients who were hospitalized for percutaneous laminoplasty were divided into the control group and the experimental group with 30 patients in each group according to the length of stay. The patients in the control group were given nursing care including condition observation, waist and leg function rehabilitation exercise, waist circumference wearing and rehabilitation nursing knowledge propaganda and education after the operation. On the basis of the nursing measures of the control group, patients in the experimental group received the planned rehabilitation nursing knowledge education according to the nursing path of lumbar disc operation, and individualized rehabilitation activity training guidance according to the established rehabilitation nursing path. One week after the operation and at the time of discharge, the patients' mastery of rehabilitation nursing training knowledge, lumbar dysfunction index (ODI) and service satisfaction were evaluated. Results The first time of rehabilitation training in the experimental group was earlier than that in the control group, the results were statistically significant (P=0.000 4); the score of mastering rehabilitation nursing knowledge in the experimental group was higher than that in the control group, the results were statistically significant (P=0.002 3); the experimental group of mastering rehabilitation training activities was higher than that in the control group, the results were statistically significant (P<0.05); lumbar dysfunction index ODI in the experimental group was lower than that in the control group, the results were statistically significant (P<0.05); the satisfaction of nursing service in the experimental group was higher than that in the control group, the results were statistically significant (P<0.05). Conclusion The nursing path of lumbar disc surgery can promote the early rehabilitation training of patients, improve the mastery of postoperative rehabilitation nursing knowledge and rehabilitation training skills of patients, reduce the lumbar dysfunction index of patients, and promote the rehabilitation of patients' body function.

目的 评价经椎间孔镜术和显微镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及优缺点,并探讨该术式的有效性、安全性,以期找到更优的手术治疗腰椎间盘突出症方法及临床应用价值。方法 通过回顾性分析我院2019年1月—2019年12月经椎间孔镜下髓核摘除术及显微镜下椎板开窗减压髓核摘除术患者,总随访251例,其中椎间孔组229例,显微镜组22例。采集数据包括病例数、性别、年龄、手术时间、出血量及切口感染情况,术前、术后的JOA评分、VAS评分、ODI功能指数、改良MacNab标准,并对数据进行统计学分析。结果 椎间孔组手术采用局麻下进行,显微镜组采用全麻下进行,其中椎间孔镜组有2例患者因术中腰部剧痛不能配合完成,余患者手术完成顺利。椎间孔镜组平均病程5个月,手术时间(96±10)min,术中出血量(25.8±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为14.23±3.08、6.08±1.64、30.18±7.92,术后JOA评分、VAS评分、ODI功能指数分别是22.65±1.58、1.77±0.5、19.67±3.89,改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%。显微镜组平均病程8个月,手术时间(45±10)min,术中出血量(62±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为15.13±2.06、6.85±1.27、29.42±7.47,术后JOA评分、VAS评分、ODI功能指数分别是23.25±1.31、1.98±0.53、20.12±4.03。椎间孔镜组改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%;显微镜组改良MacNab标准为优17例,良2例,可3例,差0例,总优良率86.4%;两组患者性别、年龄与术前JOA评分、VAS评分、ODI功能指数相关性无统计学意义;9例椎间孔镜术后患者因效果差择期行显微镜下开窗手术治疗。结论 经皮椎间孔镜手术及显微镜下开窗减压髓核摘除手术治疗腰椎间盘突出症疗效均可靠,能有效改善患者下肢放射痛等临床症状,提高患者的生活质量及减轻功能障碍,但椎间孔镜组更具有微创、出血量少、术后恢复快等优势。

目的 观察普瑞巴林联合甲钴胺对腰椎手术术后急性疼痛的影响。方法 按照纳入排除标准选择2019年1月—2019年12月在我院行单一节段的腰椎手术患者共60例,缝皮时常规予0.375%罗哌卡因20 mL切口周围浸润,术后使用病人静脉自控镇痛(Patient-Controlled Intravenous Analgesia, PCIA)。患者随机分为2组,实验组:术前1天开始口服普瑞巴林75 mg bid和静脉注射甲钴胺注射液 0.5 mg qd,共5天;对照组:术前1天开始口服普瑞巴林 75 mg bid和注射等体积的生理盐水,共5天。观察术前和术后6、12、24、48 h的VAS评分,在术前、术后24 h和术后48 h进行JOA评分,记录术后24 h和48 h阿片类药物用量、PCIA按压次数、补救用药量和不良反应。结果 两组患者术后12 h内的VAS评分无差异,但是在12～48 h这段时间里实验组的静息VAS和运动VAS评分均低于对照组(P<0.05)。实验组在术后24 h和48 h舒芬太尼消耗量、PCIA按压次数和平均补救用药剂量少于对照组(P<0.05),两组患者的JOA评分和不良反应均无差异(P>0.05)。结论 普瑞巴林联合甲钴胺应用于腰椎手术患者术后镇痛效果良好,药物不良反应发生率低,但仍需进行更大规模的随机对照研究证实该镇痛方案的安全性和有效性。

Objective To observe the effect of pregabalin combined with mecobalamin on acute pain after lumbar surgery. Methods A total of 60 patients underwent single lumbar spine surgery in our hospital from January 2019 to December 2019. The incisions of patients were routinely infiltrated around the incision with 0.375% ropivacaine 20 mL. Patient-controlled intravenous analgesia (PCIA) was used. The patients were randomly divided into two groups. The experimental group: oral pregabalin 75mg bid and intravenous mecobalamin injection 0.5mg qd 1 day before surgery, five days in total. Control group: oral pregabalin 75mg bid and intravenous injection of equal volume of saline 1 day before surgery, five days in total. The VAS scores of preoperative and postoperative 6, 12, 24, and 48 h were observed. JOA scores were performed before surgery, 24 h after surgery, and 48 h after surgery. The doses of opioids, PCIA pressing times, remedial medications and adverse reactions were recorded at 24 h and 48 h after surgery. Results There was no significant difference in VAS scores between the two groups within 12 h after surgery, but the resting VAS and exercise VAS scores in the experimental group were lower than those in the control group during the period of 12～48 h (P<0.05). The amount of sufentanil, the pressing times of PCIA and the average remedial medication in the experimental group were lower than those in the control group at 24 h and 48 h after operation (P<0.05). There were no significant differences in JOA scores and adverse reactions between the two groups (P>0.05). Conclusion Pregabalin combined with mecobalamin in patients with lumbar spine surgery has good postoperative analgesia and low incidence of adverse drug reactions, but more randomized controlled trials are needed to confirm the safety and efficacy.

目的 利用椎间孔镜微创治疗腰椎管狭窄症的手术编码容易出现错编、漏编情况,找到相应的解决办法。方法 通过查阅某院脊柱关节外科2016年引进椎间孔镜微创治疗腰椎管狭窄症的88份出院病案,以2011版 ICD-9-CM-3分类中查找出现的问题。结果 发现存在编码缺陷率达34.8%。结论 对于上述病案进行手术编码时,需要查阅腰椎微创融合手术的相关知识,需要判断手术方式、路径等情况,编码员应积极与临床手术医师进行沟通,加强工作责任心,才能做出准确编码,为临床医、教、研提供最具价值的病案信息。

目的 研究脊柱经皮内镜椎间孔入路和椎板间入路治疗腰椎间盘突出的临床应用效果。方法 本次选取的研究对象为2016年1月—2017年12月期间在我院进行治疗的腰椎间盘突出患者,将60例患者根据红蓝球分组法分为两组,30例/组。将实施脊柱经皮内镜椎间孔入路椎间盘切除术的患者纳入PETD组,将采用椎板间入路椎间盘切除术的患者设为PEID组。将两组腰椎间盘突出患者的手术相关指标、治疗优良率、ODI评分、VAS评分进行比对。结果 观察组腰椎间盘突出患者的手术时间、C型臂透视次数同对照组相比存在差异(P＜0.05);术后卧床时间和住院时间、治疗优良率组间对比无统计学意义;两组术后三个月时的ODI评分、VAS评分均较术前更优(P<0.05)。结论 在腰椎间盘突出治疗中脊柱经皮内镜椎间孔入路、椎板间入路的效果相当,临床上需患者的实际情况和解剖特点选择适合的入路方式和手术方法。

目的 探讨早期康复护理干预对胸腰椎骨折内固定术后患者的临床护理效果。方法 2014年6月—2016年12月,将94例胸腰椎骨折内固定术后患者按数字随机法,分为实验组51例和对照组43例,分别实进行早期康复护理和常规性护理。比较两组患者胸腰背部功能状况、胸腰背部疼痛情况、术后抑郁水平,以及护理满意度等相关指标,以评价早期康复护理的效果。结果 94例患者均获得3个月随访。与对照组比较,实验组患者平均住院天数减少4.1 d,差异有统计学意义(P<0.05);平均住院费用也有所下降;实验组和对照组总并发症发生率分别为7.84%和20.9%,两组间比较差异有统计学意义;实验组的护理工作满意度高达90.20%,高于对照组的67.44%,差异具有统计学意义(P<0.05)。术后3个月随访时,Oswestry功能障碍评分实验组为(14.74±3.25),低于对照组的(20.04±5.32)(P<0.05); SDS评分实验组的为42.35±3.68,低于对照组的(47.28±3.49)(P<0.05);胸腰背痛VAS评分实验组的为(1.07±0.67),低于对照组的(2.62±1.86)(P<0.05)。结论 早期康复护理干预是促进胸腰椎骨折内固定术后患者快速康复的有效方法,提高患者对护理工作的满意度,值得推广应用。

Objective To evaluate and compare the outcomes of early rehabilitation nursing and routine nursing care for patients with thoracolumbar bursting fracture after internal fixation. Methods From June 2014 to December 2016, this study enrolled ninety-four subjects who were randomly divided into observe group with fifty-one cases and control group with forty-three cases according to the digital random method. Patients in the control group were treated with routine nursing care, and early rehabilitation nursing care were used in the observe group. The physical function of thoracolumbar spine, psychological condition, pain of thoracolumbar spine, nursing satisfaction and soon. were compared between the two groups. Results The average days of hospital stay in the observation group was 4.10 days, it was less than that of control group, and the difference was statistically significant(P<0.05). Average hospital costs were also declined. The total complication rate were 7.84% in observe group and 20.9% in control group, there was significant difference between the two groups (P<0.05). The nursing satisfaction was 90.20% in observe group, which was higher than 67.44% in that in control group (P<0.05). When follow-up three months after operation, the ODI score in experiment group was(14.74±3.25), which was lower than that (20.04±5.32)in control group (P<0.05). The SDS score in experiment group was (42.35±3.68), which was lower than that (47.28±3.49)in control group(P<0.05). And the VAS score in experiment group was (1.07±0.67), which was lower than that(2.62 ±1.86)in control group (P<0.05). Conclusion Early rehabilitation nursing care is effective to the rapid functional recovery for patients with thoracolumbar bursting fracture after internal fixation, and improves the nursing satisfaction.

目的 探讨无脊髓神经损伤伴有大骨块突入椎管的胸腰椎爆裂骨折后路间接减压与椎弓根固定技术的应用价值。方法 对42例无脊髓神经损伤伴有大骨块突入椎管的胸腰椎爆裂骨折患者行椎弓根螺钉内固定及后路间接减压术,未进行椎板切除,伤椎上下椎体与伤椎同时植钉进行撑开间接减压,术后随访观察伤椎椎体高度的恢复,节段后凸角的纠正,椎管内骨块复位情况以及有无神经损伤症状。结果 42例患者均获随访,术后平均随访30个月。间接减压患者伤椎前后缘高度分别是:术前53.8%、82.3%,术后91.7%、95.3%;节段后凸角分别是:术前27.1°,术后5.3°;椎管截面积术前平均51.2%,术后83.7％;术后各项指标与术前相比有差异(P＜0.01)。患者术后随访均无迟发性神经损伤发生。结论 对于椎管内骨块占位但无脊髓及神经损伤的胸腰椎爆裂骨折行后路间接减压椎弓根钉内固定可以达到良好的治疗效果。

Objective To investigate the effectiveness of posterior indirect decompression and internal fixation with pedicle screws in treating thoraclumbar burst fracture without spinal cord or nerve damage accompanied with Large bone protruding into the spinal canal. Methods 42 cases were treated with pedicle screw fixation and kept the lamina. Pedicle screws were inserted into injury vertebra and adjacent centrums, and braced them for indirect decompression at the same time. To observe the recovery of injured vertebral height, the correction of segmental kyphosis angle, the restoration of protruding bone fragment and presence of nerve injury symptoms. Results After the operation, the patients were followed up for average 30 months, by comparing indexes between preoperation and postoperation, indirect decompression patient's anterior and posterior flange height of vertebral body was 53.8% and 82.3% vs 91.7% and 95.3%, and the segmental kyphosis angle was 27.1° vs 5.3°, and the cross-sectional area of spinal canal was 51.2% vs 83.7% on average. There was a significant difference between the indexes of before and after the operation. In postoperation follow-up, no patient had delayed neurological damage. Conclusion Pedicle screw internal fixation with indirection decompression is an effective method to treat thoraclumbar burst fracture,with bone fragments in spinal canal and without nervous dysfunction.

目的 探讨胸腰椎爆裂性骨折(TLBF)应用经伤椎椎弓根钉固定结合经椎弓根植骨治疗的临床效果。方法 选取我院2013年7月—2016年7月收治的28例TLBF患者,均行经伤椎椎弓根钉固定结合经椎弓根植骨治疗。详细记录所有患者术中出血量、手术时间及住院时间等围术期情况;比较28例患者手术前后影像学指标、腰背部疼痛视觉模拟评分法(VAS)评分及Frankel分级;随访期间并发症情况。结果 与术前相比,28例患者术后1个月、3个月时的椎体前后缘高度、Cobb角及VAS评分,均更优(P<0.01);经Ridit分析知,28例患者术后6个月时Frankel分级显著优于术前(P<0.01);术后随访6个月期间内,未见内固定松动、断裂等情况,且并未发生因椎弓根植骨而引起的神经症状。结论 TLBF应用经伤椎椎弓根钉固定结合经椎弓根植骨治疗能有效复原与保持脊柱生物力学稳定性,矫正后凸畸形,减少患者术后痛苦与并发症,改善神经功能,安全可靠,具有较高临床推广价值。

Objective To investigate the effects of the pedicle screw fixation combined with pedicle bone graft in treatment of thoracolumbar burst fracture(TLBF). Methods Selected 28 patients with TLBF treated in our hospital from July, 2013 to July, 2016, all of whom were treated with the pedicle screw fixation combined with pedicle screw fixation in the treatment of vertebral pedicle screw fixation. Recorded all patients' detailed situations on preoperative period of bleeding volume, operation time and length of stays. Compared 28 patients' imaging parameters, back pain visual analogue scale (VAS) score and Frankel classification before and after operation. And to observe the complications during follow-up as well. Results Compared with the pre-operation, 28 patients' anterior and posterior margin height, Cobb angle and VAS score were significantly better (P<0.01) than that of one month and three months after the operation. According to the Ridit analysis, six months after the operation, 28 patients' Frankel classification was better than that of pre-operation (P<0.01). No internal fixation loosening or breakage was found during the follow-up period of 6 months, and there was no nerve symptoms caused by pedicle screw fixation. Conclusion The pedicle screw fixation combined with pedicle screw fixation in treatment of thoracolumbar burst fracture(TLBF) can effectively restore and maintain the biomechanical stability of the spine, correct kyphosis, reduce postoperative pain and complications, improve nerve function and be safe and reliable,have higher clinical value.

目的 研究经后路椎体间植骨融合术治疗老年退变性腰椎滑脱合并腰椎管狭窄症的临床效果。方法 将我院110例老年退变性腰椎滑脱合并腰椎管狭窄症患者抽签分为研究组与对照组,两组均为55例,研究组采取经后路椎体间植骨融合术治疗,对照组采取传统手术治疗,比较两组临床效果、Prolo评分及术中出血量、术后引流量、术后卧床时间及手术时间差异。结果 研究组总有效率与对照组总有效率分别为90.91%、92.73%,比较无统计学意义(P＞0.05);术后研究组Prolo功能、症状、总分均高于对照组(P＜0.05),滑移率比较无统计学意义(P＞0.05);研究组术中出血、术后引流量及术后卧床时间低于对照组(P＜0.05),手术时间比较无统计学意义(P＞0.05)。结论 经后路椎体间植骨融合术治疗老年退变性腰椎滑脱合并腰椎管狭窄症疗效确切,短期效果与传统术式相似,但可加快患者功能恢复,降低手术过强应激反应,具有较高的临床价值。