CAJ | 학술논문

目的：探讨后路原皮肤切口双侧肌间隙入路经Quadrant通道下TLIF术（transforaminal lumbar inter-body fusion）治疗复发性腰椎间盘突出症（recurrent lumbar disc herniation,RLDH）的临床效果。方法：2009年1月～2011年12月共治疗RLDH患者22例，年龄为35～65岁，平均51.2岁。病变节段L4/516例，L5/S16例。其中开窗减压髓核摘除术后复发10例，内窥镜下髓核摘除术后复发8例，半椎板减压髓核摘除术后复发4例。均采用后路原切口双侧肌间隙入路，经Quadrant通道下行微创TLIF术。采用JOA（29分法）功能评分对患者再次手术前、手术后1年临床疗效进行评估，并计算改善率。采用Suk法评估椎间植骨融合情况。结果：22患者均顺利完成手术，无脑脊液漏，无神经根损伤。22患者均获得随访，随访时间为18～37个月，平均24个月。术前JOA评分为9.8±1.4分，术后1年JOA评分为24.5±1.2分，与术前比较差异有统计学意义（P<0.05）。根据改善率评估临床效果，其中优20例，良2例。随访期内植骨均融合，融合时间5～12个月，平均9.3个月，无椎弓根螺钉断裂和融合器移位。结论：后路原皮肤切口双侧肌间隙入路经Quadrant通道下TLIF术是一种微创治疗RLDH的可行方法。
목적：탐토후로원피부절구쌍측기간극입로경Quadrant통도하TLIF술（transforaminal lumbar inter-body fusion）치료복발성요추간반돌출증（recurrent lumbar disc herniation,RLDH）적림상효과。방법：2009년1월～2011년12월공치료RLDH환자22례，년령위35～65세，평균51.2세。병변절단L4/516례，L5/S16례。기중개창감압수핵적제술후복발10례，내규경하수핵적제술후복발8례，반추판감압수핵적제술후복발4례。균채용후로원절구쌍측기간극입로，경Quadrant통도하행미창TLIF술。채용JOA（29분법）공능평분대환자재차수술전、수술후1년림상료효진행평고，병계산개선솔。채용Suk법평고추간식골융합정황。결과：22환자균순리완성수술，무뇌척액루，무신경근손상。22환자균획득수방，수방시간위18～37개월，평균24개월。술전JOA평분위9.8±1.4분，술후1년JOA평분위24.5±1.2분，여술전비교차이유통계학의의（P<0.05）。근거개선솔평고림상효과，기중우20례，량2례。수방기내식골균융합，융합시간5～12개월，평균9.3개월，무추궁근라정단렬화융합기이위。결론：후로원피부절구쌍측기간극입로경Quadrant통도하TLIF술시일충미창치료RLDH적가행방법。
Objectives: To investigate the surgical outcome of minimal invasive transforaminal lumbar in-terbody fusion via bilateral paramedian approach under Quadrant invasive system for recurrent lumbar disc herniation. Methods: From January 2009 to December 2011, the clinical data of 22 patients(average age 51.2 years, ranging 35-65 years old) suffering from recurrent lumbar disc herniation (10 cases under window of laminar, 8 cases under MED, 4 cases under hemilaminectomy) were reviewed retrospectively. A total of 22 segments was involved, including L4/5 in 16 cases, L5/S1 in 6 cases. All 22 cases underwent minimal inva-sive transforaminal lumbar interbody fusion via bilateral paramedian approach under Quadrant invasive system. JOA (29) score was used to evaluate the pre-and post-revision operation (12 months) outcome as well as the improvement rate. Suk′s method was used to evaluate the lumbar interbody fusion. Results: The operations were completed successfully in all the 22 patients, and no cerebrospinal fluid leakage and nerve root injury were noted. All patients were followed up for 18-37 months(mean, 24 months). The mean JOA score at pre-operation and 12 months after operation was 9.8±1.4 and 24.5±1.2 respectively, which showed statistical sig-nificance (P<0.05). Based on the improvement rate, there were 20 excellent and 2 good. All cases got bony fusion with the fusion time of 5-12 months(mean, 9.3 months). No instrument failure was noted. Conclusions:Minimal invasive transforaminal lumbar interbody fusion via bilateral paramedian approach under Quadrant invasive system is reliable and effective for the treatment of recurrent lumbar disc herniation.