CAJ | 학술논문

目的：比较应用微创经多裂肌间隙经椎间孔椎体间融合（ transforaminal lumbar interbody fusion，TLIF）单侧固定与双侧固定治疗椎间盘源性腰痛的疗效。方法2009年4月至2012年10月，将60例经临床检查和椎间盘造影确诊的单节段椎间盘源性腰痛患者随机分为两组，均在Quadrant系统辅助下经多裂肌间隙入路行TLIF手术。A组32例，行单侧钉棒内固定单枚Cage融合；B组28例，行双侧钉棒内固定单枚Cage融合。60例中男38例，女22例；年龄30~55岁，平均40.5岁；L3~4节段5例，L4~5节段35例，L5 S1节段20例。于术后3个月、6个月、18个月进行随访，观察手术时间、术中出血量、手术损伤、并发症、植骨融合及医疗费用并进行总结分析。应用视觉模拟评分系统评估患者术前、术后疼痛情况。按照改良的MacNab法评价临床效果。结果所有手术均顺利完成，术中出血A组平均120 mL，B组平均250 mL；手术时间A组平均85.5 min，B组平均120 min；治疗费用A组平均2.0万元，B组平均3.5万元；两组手术时间、出血量及治疗费用比较差异均有统计学意义（ P<0.05）；并发症A组1例硬脊膜撕裂，B组2例，同时B组有2例非减压侧螺钉损伤神经根而行二次手术。随访8~36个月，平均25.3个月，术前VAS评分两组比较差异无统计学意义（P>0.05），末次随访时同组VAS评分与术前比较差异有统计学意义（P<0.01）。植骨融合率A组93.7%，B组96.4%。临床疗效评定A组优28例，良1例，可3例，优良率90.06%；B组优23例，良2例，可1例，差2例，优良率93.2%。两组间VAS评分、临床疗效及植骨融合率差异均无统计学意义（ P>0.05）。结论微创经多裂肌间隙入路行单侧和双侧TLIF治疗椎间盘源性腰痛均能取得较好的临床疗效，单侧TLIF手术创伤小，时间短，出血少，并发症低，安全有效，费用更低，是椎间盘源性腰痛手术治疗的一种选择。目的：比較應用微創經多裂肌間隙經椎間孔椎體間融閤（ transforaminal lumbar interbody fusion，TLIF）單側固定與雙側固定治療椎間盤源性腰痛的療效。方法2009年4月至2012年10月，將60例經臨床檢查和椎間盤造影確診的單節段椎間盤源性腰痛患者隨機分為兩組，均在Quadrant繫統輔助下經多裂肌間隙入路行TLIF手術。A組32例，行單側釘棒內固定單枚Cage融閤；B組28例，行雙側釘棒內固定單枚Cage融閤。60例中男38例，女22例；年齡30~55歲，平均40.5歲；L3~4節段5例，L4~5節段35例，L5 S1節段20例。于術後3箇月、6箇月、18箇月進行隨訪，觀察手術時間、術中齣血量、手術損傷、併髮癥、植骨融閤及醫療費用併進行總結分析。應用視覺模擬評分繫統評估患者術前、術後疼痛情況。按照改良的MacNab法評價臨床效果。結果所有手術均順利完成，術中齣血A組平均120 mL，B組平均250 mL；手術時間A組平均85.5 min，B組平均120 min；治療費用A組平均2.0萬元，B組平均3.5萬元；兩組手術時間、齣血量及治療費用比較差異均有統計學意義（ P<0.05）；併髮癥A組1例硬脊膜撕裂，B組2例，同時B組有2例非減壓側螺釘損傷神經根而行二次手術。隨訪8~36箇月，平均25.3箇月，術前VAS評分兩組比較差異無統計學意義（P>0.05），末次隨訪時同組VAS評分與術前比較差異有統計學意義（P<0.01）。植骨融閤率A組93.7%，B組96.4%。臨床療效評定A組優28例，良1例，可3例，優良率90.06%；B組優23例，良2例，可1例，差2例，優良率93.2%。兩組間VAS評分、臨床療效及植骨融閤率差異均無統計學意義（ P>0.05）。結論微創經多裂肌間隙入路行單側和雙側TLIF治療椎間盤源性腰痛均能取得較好的臨床療效，單側TLIF手術創傷小，時間短，齣血少，併髮癥低，安全有效，費用更低，是椎間盤源性腰痛手術治療的一種選擇。
목적：비교응용미창경다렬기간극경추간공추체간융합（ transforaminal lumbar interbody fusion，TLIF）단측고정여쌍측고정치료추간반원성요통적료효。방법2009년4월지2012년10월，장60례경림상검사화추간반조영학진적단절단추간반원성요통환자수궤분위량조，균재Quadrant계통보조하경다렬기간극입로행TLIF수술。A조32례，행단측정봉내고정단매Cage융합；B조28례，행쌍측정봉내고정단매Cage융합。60례중남38례，녀22례；년령30~55세，평균40.5세；L3~4절단5례，L4~5절단35례，L5 S1절단20례。우술후3개월、6개월、18개월진행수방，관찰수술시간、술중출혈량、수술손상、병발증、식골융합급의료비용병진행총결분석。응용시각모의평분계통평고환자술전、술후동통정황。안조개량적MacNab법평개림상효과。결과소유수술균순리완성，술중출혈A조평균120 mL，B조평균250 mL；수술시간A조평균85.5 min，B조평균120 min；치료비용A조평균2.0만원，B조평균3.5만원；량조수술시간、출혈량급치료비용비교차이균유통계학의의（ P<0.05）；병발증A조1례경척막시렬，B조2례，동시B조유2례비감압측라정손상신경근이행이차수술。수방8~36개월，평균25.3개월，술전VAS평분량조비교차이무통계학의의（P>0.05），말차수방시동조VAS평분여술전비교차이유통계학의의（P<0.01）。식골융합솔A조93.7%，B조96.4%。림상료효평정A조우28례，량1례，가3례，우량솔90.06%；B조우23례，량2례，가1례，차2례，우량솔93.2%。량조간VAS평분、림상료효급식골융합솔차이균무통계학의의（ P>0.05）。결론미창경다렬기간극입로행단측화쌍측TLIF치료추간반원성요통균능취득교호적림상료효，단측TLIF수술창상소，시간단，출혈소，병발증저，안전유효，비용경저，시추간반원성요통수술치료적일충선택。
Objective To investigate the clinical outcome of unilateral and bilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus by Quadrant system for discogenic low back pain. Methods Be-tween December 2009 and August 2012,60 patients presenting with discogenic low back pain of singal segment underwent ped-icle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus by Quadrant system. 32 cases underwent a unilateral pedicle screw fixation with intervertebral body fusion( group A ),while 28 cases underwent bilateral pedicle screw fixation with intervertebral body fusion(group B). There were 38 males and 22 females with the mean age of 40. 5 years( range,30~55 years). There were 35 cases of L4~5 fusion,20 cases of L5 S1 fusion and 5 cases of L3~4 fusion. The op-erative time,intraoperative blood loss,complications and the cost were observed. VAS score system was used to evaluate the pre-and post-operative back pain. The clinical outcomes were assessed by the MacNab method and the fusion rates was evalua-ted by the literature method. Results The average operative time was 85. 5 min in group A,120 min in group B;the average intraoperative blood loss was 120 mL in group A,250 mL in group B. The average cost in group A was 20 000 RWB and 35 000 RMB in group B. The blood loss,operation time and cost between two groups showed remarkable difference(P<0. 05). Preop-erative VAS score between two groups showed no significant difference(P>0. 05). After an follow-up of 25. 3 months(range, 8~36 months),VAS score between two groups at final follow-up showed no significant difference(P>0. 05). The excellent rate and bone fusion rate between two groups showed significant difference(P>0. 05). Conclusion Unilateral and bilateral pedicle screw fixation plus single cage interbody fusion through spatium intermuscalare of muhifidus are both optional for disco-genic low back pain. Unilateral pedicle screw fixation has advantages of minimal invasiveness,less blood loss,less cost,less complications and reliable curative effect. It is a satisfactory operative method for discogenic low back pain.