CAJ | 학술논문

目的：对比分析微创经椎间孔椎间融合术（MIS-TLIF）联合单侧内固定技术与联合双侧内固定技术在治疗单节段腰椎退行性疾病中的临床疗效。方法：回顾性分析2009年10月～2012年1月收治的因单节段腰椎退行性疾病行腰椎后路融合术并获得随访的65例患者。采用METRx-MD辅助下MIS-TLIF手术，其中31例患者采用MIS-TLIF联合单侧内固定技术（单侧组），男性17例，女性14例，平均57.3岁；34例患者采用MIS-TLIF联合双侧经皮内固定技术（双侧组），男性16例，女性18例，平均58.9岁。记录两组患者手术时间、出血量、术后住院天数及并发症情况。采用Oswestry功能障碍指数（ODI）评价腰椎功能情况，采用视觉模拟评分（VAS）分别对术前、术后腰痛及下肢痛进行评分。结果：术后随访18~36个月，平均26.6个月，所有患者术后12个月均获得骨性融合。单侧组手术时间80~145min，平均（101.4±27.2）min，术中出血30~100ml，平均（52.5±39.7）ml，术后住院3~7d，术后平均住院（4.4±1.5）d，1例患者硬膜囊撕裂，1例患者术后腰部切口脂肪液化，切口延迟愈合，术后随访期间腰痛和腿痛VAS评分与ODI评分与术前相比均明显改善。双侧组手术时间120~165min，平均（143.1±22.5）min，术中出血40~200ml，平均（106.3±53.8）ml，术后住院4~10d，术后平均住院（6.6±2.1）d，术后VAS、ODI评分较术前明显改善。两组间各时间点的VAS、ODI评分没有显著差异，但手术时间、出血量及住院时间单侧组优于双侧组。术后均未发现内固定松动、断裂等并发症，术后12个月均获得骨性融合。结论：MIS-TLIF联合单侧或双侧内固定技术在治疗单节段腰椎退变性疾病方面，具有相似的治疗效果，单侧内固定具有手术时间短、出血量少及住院时间短的优势。
목적：대비분석미창경추간공추간융합술（MIS-TLIF）연합단측내고정기술여연합쌍측내고정기술재치료단절단요추퇴행성질병중적림상료효。방법：회고성분석2009년10월～2012년1월수치적인단절단요추퇴행성질병행요추후로융합술병획득수방적65례환자。채용METRx-MD보조하MIS-TLIF수술，기중31례환자채용MIS-TLIF연합단측내고정기술（단측조），남성17례，녀성14례，평균57.3세；34례환자채용MIS-TLIF연합쌍측경피내고정기술（쌍측조），남성16례，녀성18례，평균58.9세。기록량조환자수술시간、출혈량、술후주원천수급병발증정황。채용Oswestry공능장애지수（ODI）평개요추공능정황，채용시각모의평분（VAS）분별대술전、술후요통급하지통진행평분。결과：술후수방18~36개월，평균26.6개월，소유환자술후12개월균획득골성융합。단측조수술시간80~145min，평균（101.4±27.2）min，술중출혈30~100ml，평균（52.5±39.7）ml，술후주원3~7d，술후평균주원（4.4±1.5）d，1례환자경막낭시렬，1례환자술후요부절구지방액화，절구연지유합，술후수방기간요통화퇴통VAS평분여ODI평분여술전상비균명현개선。쌍측조수술시간120~165min，평균（143.1±22.5）min，술중출혈40~200ml，평균（106.3±53.8）ml，술후주원4~10d，술후평균주원（6.6±2.1）d，술후VAS、ODI평분교술전명현개선。량조간각시간점적VAS、ODI평분몰유현저차이，단수술시간、출혈량급주원시간단측조우우쌍측조。술후균미발현내고정송동、단렬등병발증，술후12개월균획득골성융합。결론：MIS-TLIF연합단측혹쌍측내고정기술재치료단절단요추퇴변성질병방면，구유상사적치료효과，단측내고정구유수술시간단、출혈량소급주원시간단적우세。
Objectives: To assess the surgical outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with unilateral or bilateral pedicle screw instrumentation for one-level degenerative lumbar spine disease. Methods: Between October 2009 and January 2012, a total of 65 patients underwent 1-level MI-TLIF by one surgeon in our hospital. All patients underwent minimally invasive unilateral decompression, interbody fusion and pedicle screw fixation with the assistance of microscopic tubular retractor system(METRx-MD). 31 patients (17 males and 14 females; average age of 57.3 years) underwent MI-TLIF plus unilateral pedicle screw fixation(group A), while 34 patients(16 males and 18 females; average age of 58.9 years) un-derwent MI-TLIF plus bilateral pedicle screw fixation(group B). Operation time, blood loss, postoperative hos-pital duration and complications were evaluated. The Oswestry disability index (ODI) score and visual analog scale (VAS) pain score were obtained for all patients 24 hours before operation and at each follow-up. Re-sults: The mean follow-up was 26.6 months, with a range of 18 to 36 months. All patients showed evidence of fusion at 12 months postoperatively. The average operation time was (101.4 ±27.2)min for group A and (143.1±22.5)min for group B, the average operative blood loss was (52.5±39.7)ml for group A and (106.3±53.8)ml for group B, the average postoperative hospital duration was 4.4±1.5d for group A and 6.6±2.1d for group B, there was significant difference between 2 groups. The average postoperative VAS and ODI scores improved significantly in each group. No significant differences were found between 2 groups with respect to ODI and VAS scores. Conclusions: One-level unilateral pedicle screw instrumented MIS-TLIF provides simi-lar outcomes to that of bilateral, with shorter operation time, less bleeding and shorter hospital duration.