CAJ | 학술논문

目的前瞻性评价腰椎手术中应用脊柱后正中旁肌肉间隙入路在神经根减压和减少肌肉损害等方面的作用.方法 2007年1月至2008年5月收治30例下腰痛患者,男性19例,女性11例,22～80岁,平均56岁,包括下腰退变8例,腰椎滑脱6例,腰椎间盘突出11例,再次手术5例.采用后正中单一切口,移动至两侧椎旁肌群,经椎旁肌群间隙直接到达上下关节突表面,在上下椎板黄韧带间隙,沿上下关节突内沿逐步切除,向外侧扩大神经根管开口部,进行局限精确但有效的减压,直至显露行走根及椎间隙,不必全部切除上下关节突,更不必破坏棘间韧带、棘上韧带及黄韧带、行椎板切除.撑开调整椎间隙,对滑脱进行复位,进入椎间隙清除髓核,进行椎间植骨融合.结果狭窄椎间隙恢复高度,滑脱获解剖复位.无螺钉植入失当.下腰生理曲度排列好,无神经损伤并发症.本组术后疼痛症状获明显改善,VAS评分由术前7.5降至术后1.5.结论经椎旁肌群间隙入路,可直接到达上下关节突及软性椎管表面,无需行椎板切除减压,在达到解除压迫、缓解症状、稳定脊柱的同时,最大限度的减少创伤,保留脊柱的原始解剖结构.
목적 전첨성평개요추수술중응용척주후정중방기육간극입로재신경근감압화감소기육손해등방면적작용.방법 2007년1월지2008년5월수치30례하요통환자,남성19례,녀성11례,22～80세,평균56세,포괄하요퇴변8례,요추활탈6례,요추간반돌출11례,재차수술5례.채용후정중단일절구,이동지량측추방기군,경추방기군간극직접도체상하관절돌표면,재상하추판황인대간극,연상하관절돌내연축보절제,향외측확대신경근관개구부,진행국한정학단유효적감압,직지현로행주근급추간극,불필전부절제상하관절돌,경불필파배극간인대、극상인대급황인대、행추판절제.탱개조정추간극,대활탈진행복위,진입추간극청제수핵,진행추간식골융합.결과 협착추간극회복고도,활탈획해부복위.무라정식입실당.하요생리곡도배렬호,무신경손상병발증.본조술후동통증상획명현개선,VAS평분유술전7.5강지술후1.5.결론 경추방기군간극입로,가직접도체상하관절돌급연성추관표면,무수행추판절제감압,재체도해제압박、완해증상、은정척주적동시,최대한도적감소창상,보류척주적원시해부결구.
Objective To prospectively evaluate the clinical effects of posterior paramedian approach in nerve root decompression and reducing muscle damage in low back surgeries. Methods Study group included 30 cases treated from January 2007 to May 2008, DDD 8 cases, spondylolisthesis 6 cases,LDH 11 cases, Low back surgery failure re-operation 5 cases. Based on the comprehensive understanding of modern spine anatomy, we abandoned laminectomy in our procedure, applied a mid-waist skin incision,dissect to the paraspinal muscles where you could easily reach the facets by separating between the multifidus and longissimus, enlarge the canal by performing resection along ligamentum flavum and the inner broader of the articular process, remove enough tissue till you could expose the traversing root and the disc space, this method could achieve a limited but precise and effective decompression with not taking out all of the articular process. Once the anatomy mark of the pedicle is located (usually would be at the central area of the incision), pedicle screws placement would be precise and easy without struggling with muscle traction. The following procedures would be Spondylolisthesis reduction, discectomy and interbody fusion. Results Post-op patients of study group all showed significant improvement of pain symptoms, VAS reduced from 7.14±1.8, pre-op to 1.39±0. 72 post-op, narrowed disc space regained height, spondylolisthesis reached anatomic reduction, no complications such as pedicle screw misplacement and nerve root damage were found, the lumbar spine regained it's physiological lordosis structure. Significant difference is discovered (P <0.001) in statistic study concerning the rate of intractable low back pain between pre-op and post-op.Conclusions Applying low back surgery through posterior para-median approach could directly reach the inferior/superior facets and the "soft" structures of the spinal canal, expose the exact decompression region and anatomy mark of the pedicle in the central surgical field without strong retraction on the para-spinal muscles. This approach has the advantage of lowering the surgical difficulty of implantation, reducing the risk of nerve damage and is also a minimum invasive procedure. In many cases, laminectomy is unnecessary, leaving the lamina intact could preserve the physiological anatomy of the spine.