CAJ | 학술논문

目的：探讨经 Wiltse 入路椎管减压 Dynesys 固定治疗退变性腰椎管狭窄症的应用效果。方法将2011年10月至2013年10月收治的32例单节段退变性腰椎管狭窄症患者随机分为经 Wiltse 入路组和后正中入路组，Wiltse入路组15例，男9例，女7例，年龄42~65岁，平均51岁；后正中入路组17例，男10例，女7例；年龄40~62岁，平均53岁。通过对两组的围术期指标（手术时间、术中出血量、术后引流量及患者术前术后腰部疼痛视觉模拟量表（visual analogue scale，VAS）评分和腰背下肢 Oswestry 功能障碍指数（oswestry disability index，ODI）进行比较，评价 Wiltse 入路椎管减压 Dynesys 固定治疗退变性腰椎管狭窄症的临床疗效。结果32例患者得到6~9个月的随访，两组患者对比研究显示经 Wiltse 入路组手术时间、术中出血量、术后引流量少于后正中入路组；术后3 d 及14 d 腰痛评分改善程度优于后正中入路组；术后1个月 ODI 优于后正中入路组，术后6个月 ODI 两组无明显差异。结论 Wiltse 入路植入Dynesys 系统，椎管减压具有创伤小、出血少、术后患者恢复更快等特点，是符合微创理念的一种实用手术方式。
목적：탐토경 Wiltse 입로추관감압 Dynesys 고정치료퇴변성요추관협착증적응용효과。방법장2011년10월지2013년10월수치적32례단절단퇴변성요추관협착증환자수궤분위경 Wiltse 입로조화후정중입로조，Wiltse입로조15례，남9례，녀7례，년령42~65세，평균51세；후정중입로조17례，남10례，녀7례；년령40~62세，평균53세。통과대량조적위술기지표（수술시간、술중출혈량、술후인류량급환자술전술후요부동통시각모의량표（visual analogue scale，VAS）평분화요배하지 Oswestry 공능장애지수（oswestry disability index，ODI）진행비교，평개 Wiltse 입로추관감압 Dynesys 고정치료퇴변성요추관협착증적림상료효。결과32례환자득도6~9개월적수방，량조환자대비연구현시경 Wiltse 입로조수술시간、술중출혈량、술후인류량소우후정중입로조；술후3 d 급14 d 요통평분개선정도우우후정중입로조；술후1개월 ODI 우우후정중입로조，술후6개월 ODI 량조무명현차이。결론 Wiltse 입로식입Dynesys 계통，추관감압구유창상소、출혈소、술후환자회복경쾌등특점，시부합미창이념적일충실용수술방식。
Objective To observe the early clinical outcomes and safety of hemilaminectomy and Dynesys system implantation through Wiltse paraspinal approach and conventional posterior midline approach for the treatment of single-segment degenera-tive lumbar spinal stenosis. Methods 32 patients with single-segment degenerative lumbar spinal stenosis were treated by hemilaminectomy and Dynesys system implantation and divided into 2 groups according to the different surgical approaches. The effects were evaluated by operation time,bleeding volume,postoperative drainage volume,incision pain and post operation dysfunction. Incision pain was measured by visual analog scale(VAS)on the 3rd day and the 14th day after operation. Post operation dysfunction was measured by Oswestry disability index(ODI)on the day before operation,in the 1st month and the 6th month after operation. Results 32 patients were followed up for 6 to 9 months. The statistics showed that there were less operation time,bleeding volume,and postoperative drainage volume in the Wiltse paraspinal approach group(P ﹤ 0. 05). The VAS scores of the 3rd day and the 14th day after operation were lower in wiltse approach group than in conventional posterior midline approach(P ﹤ 0. 05). The ODI scores in the 1st month were lower in wiltse approach group(P ﹤ 0. 05),but there were no differences in ODI scores 6 months after operation. Conclusion The results suggested that Wiltse approach has less nega-tive effect on paraspinal muscles than conventional approach and has advantages of less injury,less bleeding and quick recover-y. So it complys with the concept of minimally invasive surgery and is worth to be popularized in clinic practices.