CAJ | 학술논문

目的：探讨经椎间孔行腰椎间融合（transforaminal lumbar interbody fusion，TLIF）联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症的临床疗效。方法回顾性分析2009年6月～2013年2月本院16例高位腰椎间盘突出症患者临床资料，均采用TLIF联合单侧椎弓根螺钉固定术治疗；采用腰腿痛视觉模拟评分测评入院时和TLIF联合单侧椎弓根螺钉固定术后（术后1周、1个月、3个月及末次随访）患者疼痛情况，末次随访采用改良MacNab标准评定临床疗效，并了解椎间融合情况。结果16例患者手术后随访12～52个月，平均24.2个月。所有患者均无神经损伤和脑脊液漏并发症发生。患者术后不同时期的VAS评分与术前比较差异均有显著性（P＜0.01）。采用改良MacNab 标准评价临床疗效，优良率为93.75%。末次随访时行X线检查，均无内固定失效和椎间不融合发生。结论 TLIF联合单侧椎弓根螺钉固定术治疗高位腰椎间盘突出症疗效满意，具有创伤小、并发症少、费用低的优点。
목적：탐토경추간공행요추간융합（transforaminal lumbar interbody fusion，TLIF）연합단측추궁근라정고정술치료고위요추간반돌출증적림상료효。방법회고성분석2009년6월～2013년2월본원16례고위요추간반돌출증환자림상자료，균채용TLIF연합단측추궁근라정고정술치료；채용요퇴통시각모의평분측평입원시화TLIF연합단측추궁근라정고정술후（술후1주、1개월、3개월급말차수방）환자동통정황，말차수방채용개량MacNab표준평정림상료효，병료해추간융합정황。결과16례환자수술후수방12～52개월，평균24.2개월。소유환자균무신경손상화뇌척액루병발증발생。환자술후불동시기적VAS평분여술전비교차이균유현저성（P＜0.01）。채용개량MacNab 표준평개림상료효，우량솔위93.75%。말차수방시행X선검사，균무내고정실효화추간불융합발생。결론 TLIF연합단측추궁근라정고정술치료고위요추간반돌출증료효만의，구유창상소、병발증소、비용저적우점。
Objective To investigate the clinical effect of transforaminal lumbar interbody fusion (TLIF) combined with unilateral pedicle screw fixation for upper lumbar disc herniation. Methods Retrospectively analysed the clinical data of 16 patients with upper lumbar disc herniation from Jun 2009 to Feb 2013 in our hospital, who were treated with transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation;using the visual analogue scale assessed the pain degree of patients at admission and after operation; assessed the clinical efficacy at last follow-up according to the modified MacNab criteria and observed intervertebral fusion. Results 16 patients were followed up 12 to 52 months (average 24.2 months) after surgery. All the patients had no nerve damage and leakage of cerebrospinal fluid complications. VAS score at different postopera-tive periods had significant difference compared with the VAS score before operation (P<0.01). According to the modified Mac-Nab criteria,the excellent and good rate was 93.75%. X-ray examination showed that there were no internal fixation failure and lumbar interbody non-fusion at the last follow-up. Conclusion Transforaminal lumbar interbody fusion combined with uni-lateral pedicle screw fixation has satisfied effect in the treatment of upper lumbar disc herniation,and has the advantages of small trauma,less complications,low cost.