CAJ | 학술논문

目的：观察腰椎管狭窄症伴退变性Ⅰ度滑脱患者经半椎板减压+椎间植骨融合(单枚Cage)+单侧椎弓根内固定术治疗的临床效果。方法回顾分析2008年3月至2012年3月收治的34例诊断为腰椎管狭窄症伴退变性Ⅰ度滑脱的患者，平均年龄(63.4±7)岁，平均病程(48±8)个月。病变平面：L4~520例、L5~S114例。均应用半椎板减压+椎间植骨+单侧椎弓根内固定手术方法。采用北美脊柱外科协会的腰椎功能障碍指数(ODI)评价术后3、12个月腰椎功能改善率；采用疼痛视觉模拟评分法(VAS)对术前、术后3、6、12个月随访时的腰痛及腿痛症状进行评分，并对结果进行统计学分析。结果本组28例患者获得随访，随访时间12~42个月，平均(26±5)个月。术后3、12个月功能改善优良率分别为89.3%、85.8%。术后功能3个月及12个月比较差异无统计学意义(P>0.05)。术后3个月腰腿痛VAS评分较术前明显减少(P<0.01)，术后3、6、12个月比较差异均无统计学意义(P>0.05)。5例患者发生并发症，其中硬脊膜撕裂3例、神经根损伤1例、切口感染1例。随访12个月全部椎间植骨融合没有滑脱及内固定断裂发生。结论腰椎管狭窄症伴退变性Ⅰ度滑脱患者，采用半椎板减压+椎间融合+单侧椎弓根内固定治疗可获得满意的临床效果。
목적：관찰요추관협착증반퇴변성Ⅰ도활탈환자경반추판감압+추간식골융합(단매Cage)+단측추궁근내고정술치료적림상효과。방법회고분석2008년3월지2012년3월수치적34례진단위요추관협착증반퇴변성Ⅰ도활탈적환자，평균년령(63.4±7)세，평균병정(48±8)개월。병변평면：L4~520례、L5~S114례。균응용반추판감압+추간식골+단측추궁근내고정수술방법。채용북미척주외과협회적요추공능장애지수(ODI)평개술후3、12개월요추공능개선솔；채용동통시각모의평분법(VAS)대술전、술후3、6、12개월수방시적요통급퇴통증상진행평분，병대결과진행통계학분석。결과본조28례환자획득수방，수방시간12~42개월，평균(26±5)개월。술후3、12개월공능개선우량솔분별위89.3%、85.8%。술후공능3개월급12개월비교차이무통계학의의(P>0.05)。술후3개월요퇴통VAS평분교술전명현감소(P<0.01)，술후3、6、12개월비교차이균무통계학의의(P>0.05)。5례환자발생병발증，기중경척막시렬3례、신경근손상1례、절구감염1례。수방12개월전부추간식골융합몰유활탈급내고정단렬발생。결론요추관협착증반퇴변성Ⅰ도활탈환자，채용반추판감압+추간융합+단측추궁근내고정치료가획득만의적림상효과。
Objective To investigate the clinical results of unilateral laminectomy combined with spinal fu-sion and unilateral pedicle screw instrumentation in the treatment of 34 cases of lumbar spinal stenosis with grade 1 de-gengrative spondylisthesis. Methods From March 2008 to March 2012, 34 patients with degenerative lumbar spinal stenosis with grade 1 degengrative spondylisthesis were enrolled in a restrospective study to investigate the outcome of surgical treatment:the average age was (63.4±7) year, and the average history was (48±8) months. All patients were treated by unilateral laminectomy combined with spinal fusion and unilateral pedicle screw instrumentation. Clinical outcomes were evaluated by oswestry disability index (ODI) at 3, 12 months after the operation, and low back and leg pain were evaluated by visual analogue scale (VAS) scores at pre-operation and post-operation at 3, 6, 12 months. Results 28 patients were followed up for 12 to 42 months with a mean period of (26 ± 5) months. According to the standardization of oswestry disability index (ODI), the excellent good rate was 89.3%and 85.8%at 3, 12 months re-spectively after operation (P>0.05). The VAS score of low back pain and leg pain at 3 month postoperative was lower than at preoperative (P<0.01), and there was on significant difference among 3, 6, 12 months (P>0.05). Five patients showed complications, including dural tearing in 3 patients, nerve root impingement in 1 patient, and wound infection in 1 patient. All patients gained bone graft fusion in 12 months and on spondylolisthesis and internal fixation breakage during the follow-up. Conclusion Unilateral laminectomy combined with spinal fusion and unilateral pedicle screw instrumentation shows a satisfactory result in lumbar spinal stenosis with grade 1 degengrative spondylisthesis.