CAJ | 학술논문

目的：探讨经肌间隙入路椎弓根固定结合经椎间孔椎间融合（transforaminal lumbar interbody fusion， TLIF）治疗复发性腰椎间盘突出症伴腰椎不稳的临床疗效。方法：2008年3月至2010年5月收治35例复发性腰椎间盘突出症，其中15例行经肌间隙入路单边椎弓根固定结合TLIF术式（单边固定组），20例行后正中入路双边椎弓根固定结合后路椎间植骨融合（posterior lumbar interbody fusion，PLIF）术式（双边固定组）。观察手术时间、术中出血量，并比较手术前后两组患者JOA评分、腰痛及腿痛VAS评分及融合情况。结果：所有患者获得随访，时间6～30个月，平均16．8个月。两组患者腰腿痛等临床症状较术前明显缓解，X线片显示植骨融合良好（双边固定组中1例未融合），无融合器移位、下沉及内固定器械松动或断裂。两组患者手术时间、术中出血量比较差异有统计学意义（P＜0．05）。术后JOA评分均较术前降低（P＜0．05）。术后1周，两组患者腰痛VAS评分比较差异有统计学意义（P＜0．05），腿痛VAS评分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：两种术式在治疗复发性腰椎间盘突出症伴腰椎不稳均可达到满意的疗效，经肌间隙入路单边椎弓根固定结合TLIF术式切口较小，手术时间较短，术中出血量较少，术后腰痛缓解较快。
목적：탐토경기간극입로추궁근고정결합경추간공추간융합（transforaminal lumbar interbody fusion， TLIF）치료복발성요추간반돌출증반요추불은적림상료효。방법：2008년3월지2010년5월수치35례복발성요추간반돌출증，기중15례행경기간극입로단변추궁근고정결합TLIF술식（단변고정조），20례행후정중입로쌍변추궁근고정결합후로추간식골융합（posterior lumbar interbody fusion，PLIF）술식（쌍변고정조）。관찰수술시간、술중출혈량，병비교수술전후량조환자JOA평분、요통급퇴통VAS평분급융합정황。결과：소유환자획득수방，시간6～30개월，평균16．8개월。량조환자요퇴통등림상증상교술전명현완해，X선편현시식골융합량호（쌍변고정조중1례미융합），무융합기이위、하침급내고정기계송동혹단렬。량조환자수술시간、술중출혈량비교차이유통계학의의（P＜0．05）。술후JOA평분균교술전강저（P＜0．05）。술후1주，량조환자요통VAS평분비교차이유통계학의의（P＜0．05），퇴통VAS평분비교차이무통계학의의（P＞0．05）；말차수방，요통급퇴통VAS평분량조비교차이무통계학의의（P＞0．05）。결론：량충술식재치료복발성요추간반돌출증반요추불은균가체도만의적료효，경기간극입로단변추궁근고정결합TLIF술식절구교소，수술시간교단，술중출혈량교소，술후요통완해교쾌。
Objective:To explore the clinical effects of unilateral pedicle screw fixation and transforaminal lumbar inter-body fusion (TLIF) through paraspinal muscle approach for recurrent lumbar disc herniation combined with lumbar instability. Methods:A total of 35 patients with recurrent lumbar disc herniation combined with lumbar instability were treated between March 2008 and May 2010,including 15 patients managed by the paraspinal muscle approach with unilateral pedicle screw fixation and transforaminal lumbar interbody fusion (TLIF) (unilateral fixation group) and 20 patients by the posterior midline approach with bilateral pedicle screw fixation and posterior lumbar interbody fusion (bilateral fixation group). Operation time and intraoperative blood loss were observed ,preoperative and postoperative JOA score and VAS score in low back pain and legs pain,the interbody fusion condition were compared between two groups. Results:All patients were followed up from 6 to 30 months with an average 16.8 months. All clinical symptoms had obviously improved postoperatively. X rays showed good in-terbody fusion (only 1 case did not obtain fusion in bilateral fixation group ) without cage displacement or settlement and im-plant loosening or breakage. There was significant difference in operation time and the intraoperative blood loss between two groups (P<0.05). Postoperative JOA score had obviously decreased than preoperative one (P<0.05). At 1 week after surgery, there was significant difference in VAS score of low back pain between two groups and there was no significant difference in VAS score of legs pain between two groups (P>0.05);at final follow up,there was no significant difference in VAS score of low back pain and legs pain between two groups (P>0.05). Conclusion:Two methods both can obtain satisfactory effect in treating recurrent lumbar disc herniation combined with lumbar instability. Through the paraspinal muscle approach with unilateral pedicle screw fixation and TLIF has advantages of smaller surgical incision,shorter operation time,less intraoperative blood loss,faster relief in low back pain after operation,etc.