CAJ | 학술논문

目的：比较经椎旁肌间隙入路单侧椎弓根固定结合改良后路经椎间孔椎间融合（TLIF）术与后正中入路后路腰椎椎间融合（PLIF）术治疗腰椎退变性疾病的疗效。方法腰椎退变性疾病患者38例中18例行经椎旁肌间隙入路单侧椎弓根固定结合改良TLIF术（单侧改良TLIF组），20例行后正中入路后路腰椎椎间融合（PLIF）术（PLIF组），比较两种术式切口长度、手术时间、术中出血量，手术前后JOA评分、腰痛及腿痛VAS评分，末次随访采用改良Macnab标准评估比较两组疗效。结果随访28~35个月，平均33.6个月，末次随访单侧改良TLIF组优良率94.4%；PLIF组85.0%；无融合器移位、下沉及钉棒松动、断裂发生。两组手术切口长度、手术时间、术中出血量比较差异有统计学意义（P<0.05）。术后JOA评分较术前两组均有明显降低（P<0.05）。术后1周腰痛VAS评分两组比较差异有统计学意义（P<0.05），腿痛VAS评分两组比较差异无统计学意义（P>0.05）；末次随访腰痛及腿痛VAS评分两组比较差异无统计学意义（P>0.05）。结论两种术式治疗腰椎退变性疾病均可达到满意的疗效，比较而言，经椎旁肌间隙入路单侧椎弓根固定结合改良后路经椎间孔椎间融合（TLIF）术有手术切口小、术中出血量少、术后腰背肌疼痛缓解快等优势。临床应用中需严格掌握手术适应症。
목적：비교경추방기간극입로단측추궁근고정결합개량후로경추간공추간융합（TLIF）술여후정중입로후로요추추간융합（PLIF）술치료요추퇴변성질병적료효。방법요추퇴변성질병환자38례중18례행경추방기간극입로단측추궁근고정결합개량TLIF술（단측개량TLIF조），20례행후정중입로후로요추추간융합（PLIF）술（PLIF조），비교량충술식절구장도、수술시간、술중출혈량，수술전후JOA평분、요통급퇴통VAS평분，말차수방채용개량Macnab표준평고비교량조료효。결과수방28~35개월，평균33.6개월，말차수방단측개량TLIF조우량솔94.4%；PLIF조85.0%；무융합기이위、하침급정봉송동、단렬발생。량조수술절구장도、수술시간、술중출혈량비교차이유통계학의의（P<0.05）。술후JOA평분교술전량조균유명현강저（P<0.05）。술후1주요통VAS평분량조비교차이유통계학의의（P<0.05），퇴통VAS평분량조비교차이무통계학의의（P>0.05）；말차수방요통급퇴통VAS평분량조비교차이무통계학의의（P>0.05）。결론량충술식치료요추퇴변성질병균가체도만의적료효，비교이언，경추방기간극입로단측추궁근고정결합개량후로경추간공추간융합（TLIF）술유수술절구소、술중출혈량소、술후요배기동통완해쾌등우세。림상응용중수엄격장악수술괄응증。
Objective Comparison on therapeutic effects of the paraspinal muscle approach with unilateral pedicle screw fixation plus modified transforaminal lumbar interbody fusion(TLIF)and the posterior midline approach with posterior lumbar interbody fusion(PLIF)in treating degenerative lumbar spinal disorders. Methods A total of 38 patients with degenerative lumbar spinal disorders were treated between june 2007 and october 2010,including 18 patients managed by the paraspinal muscle approach with unilateral pedicle screw fixation plus modified transforaminal lumbar interbody fusion(TLIF)(unilateral modified TLIF group)and 20 patients by the posterior midline approach with posterior lumbar interbody fusion(PLIF)(PLIF group). The length of the surgical incision,the intra-operative blood loss,the operation time,the JOA score and the VAS score in low back and legs pain in before and after operation were compared. Excellent and good resumed rate was Accorded to modified Macnab's criteria at the last follow-up. Results All patients had been follow-up for 28~35 months(average 33.6 months),excellent and good resumed rate of the unilateral modified TLIF group was94.4%at the last follow-up,the PLIF group was94.4%. There was no cage displacement or settlement and implant loosening or breakage. The length of the surgical incision,the operation time and the intra-operative blood loss of the unilateral modified TLIF group and the PLIF group showed significant difference(P<0.05). Both groups presented significant decrease of JOA score post-operatively(P<0.05).The two groups showed significant difference concerning the VAS score in low back pain one week post-operatively(P<0.05),but no significant difference in terms of VAS score in leg pain at one week after operation (P>0.05)and VAS score in pain of low back and legs at the final follow-up(P>0.05). Conclusions Two kinds of operative methods in treatment of degenerative lumbar spinal disorders can reach satisfactory curative effect. Comparing with TLIF group,the therapy of the paraspinal muscle approach with unilateral pedicle screw fixation plus modified transforaminal lumbar interbody fusion (TLIF)is of smaller surgical incision,less intra-operative blood loss,faster relief in low back pain after operation. but should be strict to indications.