CAJ | 학술논문

背景:既往多采用双侧显露,双侧椎弓根钉置入固定治疗退行性腰椎不稳,手术风险较大,出血较多,手术时间长,费用高.目的:探讨后路单枚cage单侧椎弓根钉置入内固定治疗退行性腰椎不稳的临床效果.方法:采用后路椎弓根钉及椎间融合器治疗需行内固定融合的退行性腰椎不稳患者51例,男32例,女19例,年龄41～72岁;单节段47例,双节段4例.手术方法均采用单侧显露症状侧椎板及关节突,单侧置入椎弓根钉,经椎间孔入路手术切除椎间盘及软骨终板,植骨后放入单枚cage.根据日本JOA评分法评估术后疗效.结果与结论:术中出血90～430 mL;手术时间单节段为100(85～120)min,双节段为150(120～170)min;术后第二三天即可离床活动.术后有2例患者腰腿痛无好转,复查CT和MRI均未见异常,其中1例经3个月对症处理后腰腿痛减轻,另1例无变化.按日本JOA评分法评定标准,术前JOA评分11(7～13)分,术后1年JOA评分25(18～27)分.94%患者的JOA改善率>50%.51例患者中融合44例,可能融合7例,融合时间为5.4(4.3～7.1)个月.本组未发现椎弓根螺钉松动、拔出、断钉及cage移位.说明单侧椎弓根钉及cage内固定手术方法简单,出血少,手术时间短,对脊柱结构破坏少,是治疗退行性腰椎不稳可供选择的较好方法.
배경:기왕다채용쌍측현로,쌍측추궁근정치입고정치료퇴행성요추불은,수술풍험교대,출혈교다,수술시간장,비용고.목적:탐토후로단매cage단측추궁근정치입내고정치료퇴행성요추불은적림상효과.방법:채용후로추궁근정급추간융합기치료수행내고정융합적퇴행성요추불은환자51례,남32례,녀19례,년령41～72세;단절단47례,쌍절단4례.수술방법균채용단측현로증상측추판급관절돌,단측치입추궁근정,경추간공입로수술절제추간반급연골종판,식골후방입단매cage.근거일본JOA평분법평고술후료효.결과여결론:술중출혈90～430 mL;수술시간단절단위100(85～120)min,쌍절단위150(120～170)min;술후제이삼천즉가리상활동.술후유2례환자요퇴통무호전,복사CT화MRI균미견이상,기중1례경3개월대증처리후요퇴통감경,령1례무변화.안일본JOA평분법평정표준,술전JOA평분11(7～13)분,술후1년JOA평분25(18～27)분.94%환자적JOA개선솔>50%.51례환자중융합44례,가능융합7례,융합시간위5.4(4.3～7.1)개월.본조미발현추궁근라정송동、발출、단정급cage이위.설명단측추궁근정급cage내고정수술방법간단,출혈소,수술시간단,대척주결구파배소,시치료퇴행성요추불은가공선택적교호방법.
BACKGROUND: Most of the patients suffered from degenerative lumbar instability are treated by exposure both sides and bilateral pedicle screw fixation,which bring highly operative risk,large blood loss and great medical expenditure to patients.OBJECTIVE: To explore the clinical efficacy of single cage plus unilateral pedicle screw placement for treating lumbar degenerative instability.METHODS: Totally 51 cases with lumbar degenerative instability underwent single cage plus unilateral pedicle screw placement were selected,including 32 males and 19 females,aged ranging from 41 to 72 years.47 cases had single segment involved and 4cases had two segments involved.All cases experienced unilateral laminectomy and transforamenal lumbar interbody fusion.The therapeutic effect was assessed by Japanese Orthopaedic Association(JOA)score system.RESULTS AND CONCLUSION: The blood loss was 90-430 mL.The surgical time was 100 minutes(85-120 minutes)for single segment and 150 minutes(120-170 minutes)for double segments.The patients were allowed to early ambulation at 2-3 days after operation.Two cases did not get improvement on back-leg pain,but there was no abnormality from CT and MRI recheck,one case felt pain relieved after anti-symptom treatment for 3 months while the other did not relieve.The average JOA scores at pre-operation and 1 year follow-up was 11(7-13 scores)and 25(18-27 scores),respectively.The total improvement rate of JOA was larger than 50%.44 cases were evaluated as fusion and 7 cases as possible fusion.The average fusion time was 5.4 months(4.3-7.1 months).Postoperative X-ray showed no evidence of pedicle screw loosening,broken,or cage displacement.Single cage plus unilateral pedicle screw placement is characterized by simple operation,small blood loss,short operation and few interference to spine,which is a better method for treating lumbar degenerative instability.