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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 張睿詒(Ray-E Chang) | |
dc.contributor.author | Sheng-Po Huang | en |
dc.contributor.author | 黃聖博 | zh_TW |
dc.date.accessioned | 2021-06-12T18:23:08Z | - |
dc.date.available | 2007-08-24 | |
dc.date.copyright | 2007-08-24 | |
dc.date.issued | 2007 | |
dc.date.submitted | 2007-08-19 | |
dc.identifier.citation | 中文部份
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Christie.(2006) 'Minimally invasive cervical stenosis decompression.' Neurosurgery Clinics Of North America 17(4): 423-428. 43. Tanaka J, Seki N, Tokimura F, Doi K, Inoue S.(1999) Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients. Spine;24:2308–12. 44. Tomita K, Kawahara N, Toribatake Y, Heller JG.(1998) Expansive midline T-saw laminoplasty (modified spinous process-splitting) for the management of cervical myelopathy. Spine;23:32–7. 45. Vitarbo, E., R. N. Sheth, et al.(2007) 'Open-door expansile cervical laminoplasty.' Neurosurgery 60(1 Supp1 1): S154-9. 46. Waling K, Jaorvholm B, Sundelin G. Effects of training on female trapezius myalgia(2002): an intervention study with a 3-year follow-up period. Spine;27:789-96. 47. Wang, M. Y., S. Shah, et al.(2004) 'Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy.' Surgical Neurology 62(6): 487. 48. 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Yoshida M, Otani K, Shibasaki K.(1992) Expansive laminoplasty with reattachment of spinous process and extensor musculature for cervical myelopathy. Spine;17:491–7. 54. Yue, W. M., C. T. Tan, et al. (2000). 'Results of cervical laminoplasty and a comparison between single and double trap-door techniques.' Journal Of Spinal Disorders 13(4): 329-335. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/27834 | - |
dc.description.abstract | 背景:因頸椎狹窄症引起脊髓神經及脊髓神經根的壓迫,若嚴重會導致病人嚴重失能。治療多節性頸椎狹窄症多以椎板整形術為主。目前研究少見對於open-door椎板整形術與midline open-book椎板整形術之醫療資源成本及手術效果之討論。
目的:本研究以保險者觀點,針對多節性頸椎狹窄症之病人,接受open-door與midline open-book椎板整形手術之成本效果比較。 方法:採回溯病歷方式,針對台北市某醫學中心於自2000年1月1日至2007年2月17日止期間。以診斷為ICD-9-CM 721.0、722.91、723-724並手術記錄術式為椎板整形術者共78例。將接受open-door椎板整形術與midline open-book椎板整形術分為兩群組,分析兩群組在手術後住院天數、手術實行時間、手術出血量、醫療費用、術前術後Nurick scale評分差異、術前術後JOA scale評分差異、JOA scale恢復比率、術前術後椎管直徑長度差異以及術前術後椎管直徑長度增加比率。利用t-test,分析兩群組在研究變項上的差異。 結果:在手術後住院天數、手術實行時間、手術出血量、術前術後Nurick scale評分差異、術前術後JOA scale評分差異及JOA scale恢復比率上兩群組沒有顯著差異。在醫療費用支出上midline open-book椎板整形術群組較高,open-door椎板整形術群組於手術後椎管直徑長度及增加比率較長且大。比較JOA scale恢復比率及手術後椎管直徑長度增加比率,open-door椎板整形術較具成本效果優勢。 結論:針對罹患多節性頸椎狹窄症之病人,於手術治療上使用open-door椎板整形術較midline open-book椎板整形術具有成本效果。一個手術的成功最終還是必須仰賴外科醫師的判斷、經驗以及病人病情地選擇。正確的選擇病人,給予正確的手術,病人將蒙受其利。 | zh_TW |
dc.description.abstract | Background:The compression of cervical spine and nerve roots due to cervical stenosis, if patient’s condition is serious, it will cause severe disability. Laminoplasty is a practical surgical techmique for the treatment of multi-level cervical stenosis. There were few studies on terms of costs and effectiveness between open-door laminoplasty and midline open-book laminoplasty.
Objective:This study is from a point of assurer. It aimed at people with multi-level cervical stenosis, analyzed and compared the outcome of costs and effectiveness of open-door laminoplasty to that of midline open-book laminoplasty. Methods:This study retrospectively analyzed on a medical center located at Taipei from January 1 2000 to February 17 2007. Patients’ diadnosed as ICD-9-CM 721.0、722.91、723-724 and treated with laminoplasty were screened to select 78 individuals. According to approach, patients were classified into two groups, namely open-door laminoplasty and midline open-book laminoplasty. Analyzing the two groups in the days after surgery, average operating period, estimated intraoperative blood loss, difference between preoperative and poatoperative Nurick scale, difference between preoperative and poatoperative JOA scale, JOA recocer rate, difference between preoperative and poatoperative canal diameter extent, difference between preoperative and poatoperative canal diameter augment ratio. The analysis was carried out with T-test to study the difference between the two groups. Results:There was no significant difference in the days after surgery, average operating period, estimated intraoperative blood loss, difference between preoperative and poatoperative Nurick scale, difference between preoperative and poatoperative JOA scale and JOA recocer rate between open-door laminoplasty group and midline open-book laminoplasty group. In the term of medical cost, midline open-book laminoplasty group was highter. In terms of post-operative canal diameter extent and augment ratio, open-door laminoplasty group was longer and higher. Compared which laminoplasty is ascendant in JOA scale recover rate and post-operative canal diameter augment ratio, open-door laminoplasty was better to demonstrate more cost-effectiveness option of the procedures in our study. Conclusions:In our study, mentioning surgical techmique for the treatment of multi-level cervical stenosis, open-door laminoplasty is more cost-effectiveness than midline open-book laminoplasty. The success of the operation ultimately deponds on the surgeon’s judgement, experience, and patient selection. Chosing the patient correctly and treating them adequately, they will get greatest treatment. | en |
dc.description.provenance | Made available in DSpace on 2021-06-12T18:23:08Z (GMT). No. of bitstreams: 1 ntu-96-R94843015-1.pdf: 674450 bytes, checksum: 6b128dd18e44e3e4bbc4826f70e00deb (MD5) Previous issue date: 2007 | en |
dc.description.tableofcontents | 口試委員審定書
誌謝 I 中文摘要 II ABSTRACT IV 目 錄 VI 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 4 第二章 相關文獻探討 5 第一節 頸椎退化與頸椎狹窄症疾病 5 第二節 頸椎狹窄症手術介紹 7 第三節 成本效果分析 14 第四節 頸椎狹窄症病人手術前後改善效果測量方法 17 第三章 材料與方法 19 第一節 研究樣本 19 第二節 研究方法與架構 19 第三節 研究變項之定義 20 第四節 資料處理與分析 21 第四章 研究結果 23 第一節 描述性統計分析 23 第二節 推論性統計分析 31 第三節 成本效果分析 42 第五章 討論與建議 44 第一節 討論 44 第二節 結論與建議 47 第三節 研究限制 49 參考文獻 50 | |
dc.language.iso | zh-TW | |
dc.title | 多節性頸椎狹窄症不同椎板整形術之成本效果分析 | zh_TW |
dc.title | Cost-effectiveness Analysis of Different
Laminoplasty Procedures to Multi-level Cervical Stenosis | en |
dc.type | Thesis | |
dc.date.schoolyear | 95-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 黃金山(Jin-Shan Huang),楊銘欽(Ming-Chin Yang) | |
dc.subject.keyword | 頸椎狹窄症,脊髓狹窄,椎板整形術,退化性脊髓神經病變,JOA scale量表, | zh_TW |
dc.subject.keyword | Cervical Stenosis,Spinal Stenosis,Laminoplasty,Spondylotic Myelopathy,JOA scale, | en |
dc.relation.page | 63 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2007-08-20 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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