CAJ | 학술논문

目的：探讨经Quadrant通道微创TLIF术在腰椎翻修中的临床疗效。方法2004-03-2009-06我院收治的手术后行腰椎翻修患者32例，其中腰椎管狭窄症后路椎板开窗减压术后8例、腰椎间盘突出症行腰椎间盘镜手术后6例、腰椎间盘突出症行单纯椎板开窗减压髓核摘除术后15例、腰椎滑脱术后复发3例。其中L4-518例、L5-S114例。均经肌间隙在Quadrant可扩张管道系统下行微创TLIF手术。术前、术后两周、术后一年采用视觉模拟评分系统（VAS）评估患者疼痛情况；采用ODI（Oswestrydisabilityindex）评分法进行临床疗效评估。结果随访时间16～36个月，平均18个月。术前VAS评分为7.59±0.79分，术后两周VAS评分为2.41±0.91分，术后一年VAS评分为1.16±0.68分；ODI评分术前平均37.65±2.16分，术后两周平均为18.12±1.81分，术后一年平均为7.90±1.12分。VAS评分和ODI评分术前与术后两周比较有统计学差异（P＜0.05），术后两周与术后一年比较有统计学差异（P＜0.05）。所有病例均无脑脊液漏、无神经根损伤。结论经Quadrant通道微创TLIF行腰椎翻修临床效果好、切实可行。
목적：탐토경Quadrant통도미창TLIF술재요추번수중적림상료효。방법2004-03-2009-06아원수치적수술후행요추번수환자32례，기중요추관협착증후로추판개창감압술후8례、요추간반돌출증행요추간반경수술후6례、요추간반돌출증행단순추판개창감압수핵적제술후15례、요추활탈술후복발3례。기중L4-518례、L5-S114례。균경기간극재Quadrant가확장관도계통하행미창TLIF수술。술전、술후량주、술후일년채용시각모의평분계통（VAS）평고환자동통정황；채용ODI（Oswestrydisabilityindex）평분법진행림상료효평고。결과수방시간16～36개월，평균18개월。술전VAS평분위7.59±0.79분，술후량주VAS평분위2.41±0.91분，술후일년VAS평분위1.16±0.68분；ODI평분술전평균37.65±2.16분，술후량주평균위18.12±1.81분，술후일년평균위7.90±1.12분。VAS평분화ODI평분술전여술후량주비교유통계학차이（P＜0.05），술후량주여술후일년비교유통계학차이（P＜0.05）。소유병례균무뇌척액루、무신경근손상。결론경Quadrant통도미창TLIF행요추번수림상효과호、절실가행。
Objective To explore the clinical effect of minimally invasive TLIF under quadrant system in lumbar revision surgery. Methods From March 2004 to June 2009,the clinical data of 32 patients with failed back surgery syndrome (8 cases received primary surgical treatment by win-dowing of lamina for lumbar spinal stenosis,6 cases received primary surgical treatment with MED for LDH,15 cases received primary surgical treatment by windowing of lamina and discectomy for LDH,3 cases had recurrence of lunbar spondylolisthesis)were reviewed and analyzed. A total of 32 segments were involved,including L4-5 in 18 cases,L5-S1 in 14 cases. 32 cases of failed back surgery syndrome were treated with minimally invasive TLIF via bilateral muscle gap under MAST Quadrant retractor. VAS score system was used to evaluate back pain preoperation and 14 d and 12 months postoperation. The clinical outcomes were assessed by the Oswestry disability index. Results All patients were followed up for 16-36 months (average 18 months). Preoperative VAS score was 7.59±0.79,VAS score was 2.41±0.91 at 14d postoperation, 1.16±0.68 at 12 months post-operation. Oswestry disability index was 37.65 ±2.16 at preoperation,18.12 ±1.81 at 14 d postopera-tion,7.90±1.12 at 12 months postoperation. VAS score and Oswestry disability index had significant differences between preoperation and 14 d postoperation(P<0.05). VAS score and Oswestry disabili-ty index had significant differences between 14 d and 12 months postoperation (P<0.05). There were no leakage of cerebrospinal fluid and nerve root injury during the operation. Conclusion Minimally invasive TLIF for lumbar revision surgery under quadrant system is effective.