CAJ | 학술논문

目的评价传统后路环状融合术和简化后路环状融合术治疗老年人腰椎不稳症的临床疗效。方法 2005年开始使用椎弓根钉系统辅助后路环状融合术治疗60岁及以上单节段腰椎不稳症80例,58例进行2年以上随访，其中28例采用了横突间植骨的传统后路环状融合术(PLIF+PLF,A组)，30例采用不进行横突间植骨的简化后路环状融合术（PLIF+FF,B组）。术前和术后1、3、6、12、24个月应用X线评价腰椎状态及植骨融合情况，并应用视觉疼痛评分(VAS)和()swestry功能障碍指数(ODI)评价患者腰腿疼痛程度及生活功能情况。结果 A组手术时间(185.3±56.6)min，术中出血量(376.3±92.9)ml；B组手术时间(146.4±46.3)min,术中出血量（234.3±64.5）ml，两组比较手术时间和出血量差异均有统计学意义(t= 12.37和37.49，均P＜0.01)。A组28例中27例获骨性融合，融合率96.4％,B组30例中28例获骨性融合，融合率93.3％，两组骨融合率差异无统计学意义(x2=0.004,P＞0.05)。两组患者术后腰、腿痛VAS评分及ODI均较术前明显改善。术后1个月和3个月,B组腰痛VAS评分比A组显著降低（t=3.178和2.158,P＜0.05）,其余3个时间点两组之间腰痛VAS差异无统计学意义（均P＞0.05）。术后5个时间点A、B两组间腿痛VAS评分及ODI值均无统计学差别(均P＞0.05)。结论对于具有手术指征的老年腰椎不稳症患者，采用不进行横突间植骨融合的简化后路环状融合术与传统的后路环状融合术相比，可获得相似的融合率和满意的临床疗效，且创伤显著减少，是值得推荐的一种手术方式。
목적 평개전통후로배상융합술화간화후로배상융합술치료노년인요추불은증적림상료효。 방법 2005년개시사용추궁근정계통보조후로배상융합술치료60세급이상단절단요추불은증80례,58례진행2년이상수방，기중28례채용료횡돌간식골적전통후로배상융합술(PLIF+PLF,A조)，30례채용불진행횡돌간식골적간화후로배상융합술（PLIF+FF,B조）。술전화술후1、3、6、12、24개월응용X선평개요추상태급식골융합정황，병응용시각동통평분(VAS)화()swestry공능장애지수(ODI)평개환자요퇴동통정도급생활공능정황。 결과 A조수술시간(185.3±56.6)min，술중출혈량(376.3±92.9)ml；B조수술시간(146.4±46.3)min,술중출혈량（234.3±64.5）ml，량조비교수술시간화출혈량차이균유통계학의의(t= 12.37화37.49，균P＜0.01)。A조28례중27례획골성융합，융합솔96.4％,B조30례중28례획골성융합，융합솔93.3％，량조골융합솔차이무통계학의의(x2=0.004,P＞0.05)。량조환자술후요、퇴통VAS평분급ODI균교술전명현개선。술후1개월화3개월,B조요통VAS평분비A조현저강저（t=3.178화2.158,P＜0.05）,기여3개시간점량조지간요통VAS차이무통계학의의（균P＞0.05）。술후5개시간점A、B량조간퇴통VAS평분급ODI치균무통계학차별(균P＞0.05)。 결론대우구유수술지정적노년요추불은증환자，채용불진행횡돌간식골융합적간화후로배상융합술여전통적후로배상융합술상비，가획득상사적융합솔화만의적림상료효，차창상현저감소，시치득추천적일충수술방식。
Objective To compare the clinical effect of posterior circumferential fusion with versus without intertransverse process fusion on lumbar instability in aged patients. Methods The elderly with lumbar instability were treated with the posterior instrumented circumferential fusion technique in 80 cases. Among 58 patients followed up for at least 2 years, 28 cases (group A)underwent posterior circumferential fusion with intertransverse process, while 30 cases (group B)without intertransverse process. X-ray examination was used before and 1, 3, 6, 12 and 24 months after operation to evaluate the fusion condition of the bone graft, and visul analogue scale (VAS) and Oswestry disability index (ODI) questionnaire were applied to assess the pain of center back and leg,and the conventional activity.Results The operation time and blood loss were more in group A[(185.3±56.6) min and (376.3±92.9) m1] than in group B [(146.4±46.3) min and (234.3±64.5)ml (t=12.37, 37.49, P＜0.01)]. All the 58 cases were followed for at least 2 years. The 27 cases (96.4％) of group A and 28 cases (93.3％) of group B got bone fusion (x2 =0.004, P＞0.05).There were marked differences in the VAS of center back at 1 and 3 months after operation between the 2 groups (t=3.178, 2.158, both P＜0.05), while no difference at the other 3 time point. VAS about the leg pain and the ODI showed no differences between group A and B after operation (all P＞0.05). Conclusions For the lumbar instability in the elderly, the posterior circumferential fusion with or without intertransverse process fusion can achieve a similar high rate of fusion and satisfactory clinical results, and the posterior circumferential fusion without intertranaverse process is recommended for less trauma.