CAJ | 학술논문

目的探讨单侧椎弓根螺钉固定经椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)联合后外侧融合(posterolateral fusion,PLF)技术治疗腰椎退行性疾病的可行性及有效性.方法分析2006年12月至2008年8月收治的因患腰椎退行性疾病行腰椎后路融合术并获得随访的患者78例.采用单侧椎弓根螺钉固定TLIF联合PLF技术治疗48例(单侧组),男25例,女23例;年龄31～64岁,平均47.6岁.采用双侧椎弓根螺钉固定TLIF联合PLF技术治疗30例(双侧组),男21例,女9例;年龄26～66岁,平均50.5岁.使用Oswestry功能障碍指数,疼痛视觉模拟评分(visual analogue score,VAS)评估两组患者术后疗效,并比较两组患者手术时间、出血量、融合率和椎间隙塌陷率等指标.结果两组患者的Oswestry功能障碍指数、腰痛VAS评分、腿痛VAS评分在术前与术后3个月以及术后3个月与术后1年之间比较差异均有统计学意义,在术前与术后1年的评分改善方面差值比较无统计学意义.两组患者手术时间、出血量及住院费用比较差异均有统计学意义,单侧组少于双侧组.两组患者术后住院时间比较差异无统计学意义.单、双侧组融合率分别为91.7%(44/48)和93.3%(28/30).结论椎间植骨联合单侧椎弓根螺钉固定能提供较好的脊柱即刻稳定性.单侧椎弓根固定TLIF联合PLF技术作为一种治疗腰椎退行性疾病的方法,疗效满意.
목적 탐토단측추궁근라정고정경추간공추체간융합(transforaminal lumbar interbody fusion,TLIF)연합후외측융합(posterolateral fusion,PLF)기술치료요추퇴행성질병적가행성급유효성.방법 분석2006년12월지2008년8월수치적인환요추퇴행성질병행요추후로융합술병획득수방적환자78례.채용단측추궁근라정고정TLIF연합PLF기술치료48례(단측조),남25례,녀23례;년령31～64세,평균47.6세.채용쌍측추궁근라정고정TLIF연합PLF기술치료30례(쌍측조),남21례,녀9례;년령26～66세,평균50.5세.사용Oswestry공능장애지수,동통시각모의평분(visual analogue score,VAS)평고량조환자술후료효,병비교량조환자수술시간、출혈량、융합솔화추간극탑함솔등지표.결과 량조환자적Oswestry공능장애지수、요통VAS평분、퇴통VAS평분재술전여술후3개월이급술후3개월여술후1년지간비교차이균유통계학의의,재술전여술후1년적평분개선방면차치비교무통계학의의.량조환자수술시간、출혈량급주원비용비교차이균유통계학의의,단측조소우쌍측조.량조환자술후주원시간비교차이무통계학의의.단、쌍측조융합솔분별위91.7%(44/48)화93.3%(28/30).결론 추간식골연합단측추궁근라정고정능제공교호적척주즉각은정성.단측추궁근고정TLIF연합PLF기술작위일충치료요추퇴행성질병적방법,료효만의.
Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion(TLIF)and posterolateral fusion(PLF)procedures in which unilateral pedicle screw fixation was used.Methods From December 2006 to August 2008,78 cases with the lumbar degenerative diseases who received lumbar posterolateral fusion were analyzed.There were 48 cases of which underwent TLIF and PLF procedures with unilateral pedicle screw fixation(unilateral group),including 25 males and 23 females with an average of 47.6 years;and 30 cases of which underwent TLIF and PLF procedures with bilateral pedicle screw fixation(bilateral group),including 21 males and 9 females with an average of 50.5 years.The clinical effects between the two groups were evaluated with Oswestry disability index and visual analogue score(VAS)index.The operation time,blood loss,fusion rates and intervertebral collapse rates were also compared.Results Oswestry disability index,low back pain VAS index and skelalgia VAS index in both groups showed statistical significance between preoperation and 3 months,or 3 months and 1 year postoperatively.There was no difference in score improvement between the two groups.There were difference in operation time,blood loss and cost of hospitalization between unilateral and bilateral group.The former was lower.There was no difference in postoperative length of stay between the two groups.The fusion rate of unilateral group and bilateral group were 91.7%(44/48)and 93.3%(28/30),respectively.Conclusion Auto graft combined with unilateral pedicle screw fixation provids better spinal instant stability.TLIF and PLF with unilateral pedicle screw fixation was a satisfactory method in treating degenerative disease of lumbar vertebrae.