腰椎非融合与融合手术治疗腰椎间盘突出伴终板modic退变的远期疗效比较-comparison of long-term results of lumbar non-fusion and fusion surgery in the treatment of lumbar disc herniation with degenerative endplate modic.docxVIP

目录中文摘要???????????????????????????ⅠABSTRACT??????????????????????????Ⅱ前言????????????????????????????1一、临床资料?????????????????????????21.病例来源?????????????????????????22.诊断标准?????????????????????????23.病例筛选?????????????????????????2二、方法????????????????????????????31.手术方法?????????????????????????32.术后疗效评定方法?????????????????????43.统计学分析????????????????????????7三、结果????????????????????????????8四、讨论????????????????????????????91.腰椎终板Modic改变与腰椎退变及疼痛的关系?????????92.不同腰椎Modic改变分型的临床意义?????????????103.融合手术缓解腰椎Modic改变所引起的疼痛的机制???????134.关于手术临床疗效评分???????????????????155.腰椎Modic退变的中医机理探讨???????????????16五、结论????????????????????????????17六、存在问题和展望???????????????????????17参考文献????????????????????????????18致谢??????????????????????????????20文献综述????????????????????????????21中文摘要腰椎非融合与融合手术治疗腰椎间盘突出伴终板Modic退变的远期疗效比较目的：比较融合与非融合两种手术方式在治疗腰椎间盘突出伴终板Modic退变患者的远期疗效，探讨哪种手术方式更利于术后疼痛的缓解，并比较不同Modic分型的手术疗效。方法：回顾性分析109例腰椎间盘突出伴有终板Modic退变的患者，根据接受手术方式的不同分为非融合组和融合组，再根据术前腰椎MRI检查，进一步分为ModicⅠ型组，ModicⅡ型，ModicⅢ型组。记录每位患者的术前和随访末的ODI评分，统计数据，比较不同Modic分型组采用两种手术方式的疗效。结果：在ModicⅠ型、ModicⅡ型2个组别中，随访末融合组的ODI评分低于非融合组，有统计学意义（P0.05）；在ModicⅢ型组中，随访末的非融合与融合组之间ODI评分无统计学差异（P0.05）。非融合组中，ModicⅠ型与ModicⅡ型随访末的ODI评分无统计学差异（P0.05），ModicⅡ型与ModicⅢ型随访末的ODI评分无统计学差异（P0.05），ModicⅠ型与ModicⅢ型随访末的ODI评分有统计学差异（P0.05）,前者高于后者。结论：对于腰椎间盘突出伴终板ModicⅠ型、ModicⅡ型退变的患者采用融合手术方法，其术后远期疼痛缓解疗效要优于采用非融合手术的患者；而对于ModicⅢ型退变的患者，采用上述两种手术方式则没有远期疗效的显著差别。腰椎终板ModicⅠ型退变与腰痛的相关性强于ModicⅡ型，但差别无统计学意义；ModicⅡ型退变与腰痛的相关性强于ModicⅢ型，但差别无统计学意义；ModicⅠ型退变与腰痛的相关性强于ModicⅢ型，且差别有统计学意义。主题词：非融合，融合，终板Modic退变，手术疗效AbstractComparethelong-termoutcomeofthefusionandnon-fusionsurgerytreatingpatientswhohavelumbarintervertebraldiscdegenerationwithModicendplateObjective:Comparetheinfluenceofthefusionandnon-fusionsurgerytothelong-termoutcomeofpatientswhohavelumbarintervertebraldiscdegenerationwithModicendplate.Evaluatewhichtypeofsurgeryisbetterforpainrelievingaftersurgery.Andcomparelong-termoutcomebetweendifferentModictypes.Method:109casesoflumbarintervertebraldiscdegenerationwithModicendplatewereprospectivea