椎间盘形态与患者报告的微盘切除术后的结果之间的关系
Jeremy C Heard1, Teeto Ezeonu1, Yunsoo Lee1
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
World neurosurgery
|April 20, 2024
概括
在微分隔切除术患者中,洞深度大于1级,预测基线物理功能较低,但在三个月后改善更大. 手术结果和长期功能不受形态的影响.
科学领域:
- 神经外科 神经外科
- 整形外科手术 整形外科手术
- 脊柱外科手术 脊柱外科手术
背景情况:
- 微分隔切除术是腰椎椎间盘的常见手术程序.
- 的形态可能会影响手术结果和患者的康复.
- 密歇根州立大学分类提供了一种标准化的方法来评估的特征.
研究的目的:
- 利用密歇根州立大学分类,调查形态与患者报告的结果测量 (PROM) 和微分隔切除术后的外科结果之间的关联.
- 为了确定磁盘的侧面性 (中央与侧面) 和挤出等级冲击恢复.
主要方法:
- 一项对233名接受单级微隔膜切除术 (2014-2021) 的成年患者的回顾性审查.
- 根据横向性 (A区:中心,B区/C区:横向) 和挤出等级 (等级1: <=50%通道,等级>1: >50%通道) 的形形态的分类,使用手术前的MRI.
- 在手术前,3个月和1年的术后时间点收集PROMs (包括物理组件得分,视觉模拟量表,骨干学残疾指数).
主要成果:
- 在瘤形态组之间没有观察到手术结果的显著差异.
- 挤出等级大于1的患者 (延伸到中央通道的) 报告了较低的基线物理成分得分.
- 挤出等级>1是手术后3个月 (P < 0.001) 物理组分得分更大改善的重要独立预测因子,但在1年内没有.
结论:
- 虽然所有患者在微分隔切除术后都得到改善,但那些有更深层的椎间盘 (级别>1) 的患者在3个月后体力功能得到了更明显的改善.
- 的横向性和深度与视觉模拟尺度,奥斯韦斯特残疾指数或心理组件得分在3个月或12个月后的改善无关.
- 的形态学,特别是挤出等级,可以预测微分隔切除术后的短期功能恢复.
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