CAJ | 학술논문

目的：探讨经Quadrant微创通道单侧椎弓根置钉联合单枚cage经椎间孔入路腰椎体间融合术在腰椎间盘突出症中的疗效及并发症的预防。方法对31例腰椎间盘突出症患者采用全层切开法实施经Quadrant微创通道单侧椎弓根置钉联合单枚cage经椎间孔入路腰椎体间融合术。观察手术时间、出血量、切口长度、住院时间及术后并发症情况。应用视觉模拟评分系统（VAS）评定患者术前和末次随访时的疼痛程度；末次随访采用正、侧位X线片判定植骨融合率及椎间高度，并按Nakai标准评定临床疗效。结果手术时间82～180 min，平均100 min；术中出血90～200 mL，平均120 mL；切口长度3～6 cm，平均4.5 cm；住院时间5～14 d，平均7 d；术后未出现切口区明显皮缘坏死，伤口感染等并发症。所有患者获随访，平均随访时间8个月（3～16个月）。随访期间未见椎弓根钉棒松动、断裂；末次随访疼痛VAS评分由术前（7.1±1.3）分降至（2．3±1.6）分，椎间融合率93.3%，椎间隙高度前缘由术前（1.31±0.33）cm升高到术后（1.54±0.21）cm，后缘由术前（0.55±0.11）cm升高到术后（0.65±0.10）cm。临床疗效：优15例，良11例，可5例，优良率83.87%。结论经微创通道单侧椎弓根置钉联合经椎间孔入路腰椎体间融合术具有手术时间短、出血少、对人体正常组织结构破坏小、治疗费用低等优点；全层切开法对于预防皮缘坏死，脂肪液化具有良好的临床效果。
목적：탐토경Quadrant미창통도단측추궁근치정연합단매cage경추간공입로요추체간융합술재요추간반돌출증중적료효급병발증적예방。방법대31례요추간반돌출증환자채용전층절개법실시경Quadrant미창통도단측추궁근치정연합단매cage경추간공입로요추체간융합술。관찰수술시간、출혈량、절구장도、주원시간급술후병발증정황。응용시각모의평분계통（VAS）평정환자술전화말차수방시적동통정도；말차수방채용정、측위X선편판정식골융합솔급추간고도，병안Nakai표준평정림상료효。결과수술시간82～180 min，평균100 min；술중출혈90～200 mL，평균120 mL；절구장도3～6 cm，평균4.5 cm；주원시간5～14 d，평균7 d；술후미출현절구구명현피연배사，상구감염등병발증。소유환자획수방，평균수방시간8개월（3～16개월）。수방기간미견추궁근정봉송동、단렬；말차수방동통VAS평분유술전（7.1±1.3）분강지（2．3±1.6）분，추간융합솔93.3%，추간극고도전연유술전（1.31±0.33）cm승고도술후（1.54±0.21）cm，후연유술전（0.55±0.11）cm승고도술후（0.65±0.10）cm。림상료효：우15례，량11례，가5례，우량솔83.87%。결론경미창통도단측추궁근치정연합경추간공입로요추체간융합술구유수술시간단、출혈소、대인체정상조직결구파배소、치료비용저등우점；전층절개법대우예방피연배사，지방액화구유량호적림상효과。
Objective To discuss the clinical efficacy of unilateral pedicle screw fixation combined with single cage transforaminal lumbar interbody fusion via Quadrant system and the prevention of complications in lumbar intervertebral disc herniation. Methods Using full thickness cutting method, unilateral pedicle screw fixation and single cage transforaminal lumbar interbody fusion were performed via Quadrant system in 31 patients with lumbar intervertebral disc herniation. Operative time, blood loss, incision length, hospital stay and postoperative complications were observed. In addition, the degree of pain was evaluated using visual analog scale(VAS)before operation and at the last follow-up. The anteroposterior and lateral x-ray films were used to determine the fusion rate and vertebral body height and clinical efficacy was assessed with Nakai criterion at the last follow-up.Results The average operative time, intraoperative blood loss, incision length and hospital stay were 100 minutes (range, 82-180 minutes), 120 mL (range, 90-200 mL), 4.5 cm (range, 3-6 cm)and 7 days (range, 7-14 days), respectively. No skin edge necrosis, wound infection and other complications were found after operation.All patients were followed up for an average of 8 months(range, 3-16 months). No pedicle screw loose-ning and fracture occurred during follow-up. VAS score decreased from preoperative 7.1±1.3 to 2.3±1.6 at the last follow-up. Intervertebral fusion rate was 93.3%. Anterior vertebral height increased from preoperative(1.31±0.33)cm to postoperative(1.54±0.21)cm and posterior vertebral height increased from preoperative(0.55±0.11)cm to postoperative(0.65±0.10)cm. Clinical results were excellent in 15 patie-nts, good in 11 and fair in 5. The excellent and good rate was 83.87%. Conclusion Minimally invasive unilateral pedicle screw fixation combined with transforaminal lumbar interbody fusion is associated with shorter operative time, less bleeding, less damage and lower cost in the treatment of lumbar intervertebral disc herniation. Full thickness cutting can effectively prevent skin edge necrosis and fat liquefaction.