CAJ | 학술논문

目的分析改良经椎间孔椎体间融合术(TLIF)治疗腰椎间盘突出症的手术效果.方法对2005年7月至2008年6月改良TLIF治疗腰椎间盘突出症46例随访资料完整的病例进行回顾性研究.其中男32例,女14例,年龄27～65岁,平均47岁,病程4～18年,平均7.5年.单节段18例,其中L3/4 5例,L4/5 8例,L5/S1 5例,同时合并其他节段退行性变28例.术前视觉模拟疼痛评分(VAS)为(8.9±1.3)分,Oswestry功能障碍指数(ODI)为(57.3±5.2)分.患者均经至少3个月正规非手术治疗后无明显疗效.结果 46例获随访12～30个月,平均20个月.单侧椎间孔入路减压38例,双侧椎间孔入路减压8例.手术时间120～180 min,平均160 min;术中出血量400～800 ml,平均550 ml.所有患者伤口一期愈合,均未出现并发症.术后3个月时VAS和ODI评分分别为(2.0±0.4)分和(15.2±3.4)分,与术前比较差异有统计学意义(P＜O.05);VAS评分改善率为(80.1±4.7)%,ODI评分改善率为(73.6±2.8)%.术后12个月内椎体间均骨性融合,融合率100%.疗效评价:优34例,良8例,可4例,优良率91.3%.术后3 d佩戴支具下地活动,3个月患者基本恢复正常工作.结论改良经椎间孔椎间融合术是治疗腰椎间盘突出症的一种有效方法,需要术前检查与临床症状密切结合制定具体手术方案.
목적 분석개량경추간공추체간융합술(TLIF)치료요추간반돌출증적수술효과.방법 대2005년7월지2008년6월개량TLIF치료요추간반돌출증46례수방자료완정적병례진행회고성연구.기중남32례,녀14례,년령27～65세,평균47세,병정4～18년,평균7.5년.단절단18례,기중L3/4 5례,L4/5 8례,L5/S1 5례,동시합병기타절단퇴행성변28례.술전시각모의동통평분(VAS)위(8.9±1.3)분,Oswestry공능장애지수(ODI)위(57.3±5.2)분.환자균경지소3개월정규비수술치료후무명현료효.결과 46례획수방12～30개월,평균20개월.단측추간공입로감압38례,쌍측추간공입로감압8례.수술시간120～180 min,평균160 min;술중출혈량400～800 ml,평균550 ml.소유환자상구일기유합,균미출현병발증.술후3개월시VAS화ODI평분분별위(2.0±0.4)분화(15.2±3.4)분,여술전비교차이유통계학의의(P＜O.05);VAS평분개선솔위(80.1±4.7)%,ODI평분개선솔위(73.6±2.8)%.술후12개월내추체간균골성융합,융합솔100%.료효평개:우34례,량8례,가4례,우량솔91.3%.술후3 d패대지구하지활동,3개월환자기본회복정상공작.결론 개량경추간공추간융합술시치료요추간반돌출증적일충유효방법,수요술전검사여림상증상밀절결합제정구체수술방안.
Objective To evaluate the outcomes of modified transforaminal lumbar interbody fusion in patients with lumbar disc herniation. Methods Forty-six cases of lumbar disc hemiation were treated by modified transforaminal lumbar interbody fusion. There were 32 males and 14 females with a mean age of 47 years old (range :27 - 65). The mean course of disease was 7.5 years (range :4 - 18). Eighteen cases were of single-level lumbar disc herniation, including L3/4 (n = 5), L4/5 (n = 8) and L5/S1 (n = 5).There were 28 cases with lumbar degenerative diseases at other levels. Preoperatively, the score of visual analogue scale (VAS) was 8. 9±1.3 and the score of Oswestry disability index (ODI) was 57. 3 ±5.2. All patients received a normal conservative treatment for at least 3 months with no therapeutic effect at preoperation. Results Forty-six cases had an average follow-up of 20 months (range:12-20). The operative duration was an average of 160 minutes (range: 120 - 180). And the average volume of intra-operative blood loss was 550 ml (range:400-800). There was no severe complication. The symptoms became stable after three months. At 3 months postoperatively, the score of VAS was 2. 0 ± 0. 4 and the score of ODI 15. 2 ±3.4. And there were significant differences between preoperative and postoperative values (P＜0. 05). The improvement rates of postoperative VAS and ODI were(80. 1 ±4. 7)%and(73.6 ±2. 8)% respectively. All patients achieved lumbar interbody bone fusion at 12 months post-operation with a fusion rate of 100%. For the therapeutic effect, 34 cases were regarded as excellent, 8 good and 4 fair with an excellent/good rate of 91.3%. All patients began to walk with orthosis after 3 days and resumed their jobs and normal lives after 3 months. Conclusion Modified transforaminal lumbar interbody fusion is effective for the treatment of lumbar disc hemiation. Making a detailed operative plan on the basis of preoperative images and symptoms is essential.