CAJ | 학술논문

目的：比较微创经椎间孔融合内固定与传统开放经椎间孔融合内固定术治疗腰椎椎间盘突出症的临床疗效。方法2009年10月～2012年10月，对54例腰椎椎间盘突出症手术患者进行回顾性分析，其中男32例，女22例，年龄34～60岁，平均42．7岁；病变节段为L4/L534例，L5/S120例。依据手术方式将其分成微创经椎间孔腰椎椎体间融合（minimally invasive transforaminal lumbar interbody fusion ， MiTLIF）组和开放经椎间孔腰椎椎体间融合（open transforaminal lumbar interbody fusion ， OTLIF）组，分别为24例和30例。分析手术时间、手术出血量、住院时间、术中术后并发症，影像学观察术后1年椎间融合情况，采用日本骨科学会（ Japanese Orthopaedic Association ，JOA）评分评估临床效果。结果所有患者均获随访，随访时间12～36个月，平均21．4个月，MiTLIF组出血量（40．2±15．6） mL，住院时间（6．2±2．4） d，术后2周JOA评分18．7±1．9，OTLIF组出血量（203．6±52．8） mL，住院时间（10．8±4．2） d，术后2周JOA评分15．1±1．4，2组差异具有统计学意义（P＜0．05）。2组手术时间，术中术后并发症发生率，术后1个月、3个月和1年JOA评分，术后1年椎间融合率差异无统计学意义（P＞0．05）。结论在行单侧椎弓根固定治疗腰椎椎间盘突出症时，MiTLIF组出血量更少短期临床疗效更好。
목적：비교미창경추간공융합내고정여전통개방경추간공융합내고정술치료요추추간반돌출증적림상료효。방법2009년10월～2012년10월，대54례요추추간반돌출증수술환자진행회고성분석，기중남32례，녀22례，년령34～60세，평균42．7세；병변절단위L4/L534례，L5/S120례。의거수술방식장기분성미창경추간공요추추체간융합（minimally invasive transforaminal lumbar interbody fusion ， MiTLIF）조화개방경추간공요추추체간융합（open transforaminal lumbar interbody fusion ， OTLIF）조，분별위24례화30례。분석수술시간、수술출혈량、주원시간、술중술후병발증，영상학관찰술후1년추간융합정황，채용일본골과학회（ Japanese Orthopaedic Association ，JOA）평분평고림상효과。결과소유환자균획수방，수방시간12～36개월，평균21．4개월，MiTLIF조출혈량（40．2±15．6） mL，주원시간（6．2±2．4） d，술후2주JOA평분18．7±1．9，OTLIF조출혈량（203．6±52．8） mL，주원시간（10．8±4．2） d，술후2주JOA평분15．1±1．4，2조차이구유통계학의의（P＜0．05）。2조수술시간，술중술후병발증발생솔，술후1개월、3개월화1년JOA평분，술후1년추간융합솔차이무통계학의의（P＞0．05）。결론재행단측추궁근고정치료요추추간반돌출증시，MiTLIF조출혈량경소단기림상료효경호。
Objective To compare the clinical effect of minimally invasive versus open transforaminal lumbar interbody fusion with unilateral pedicle screw fixation for lumbar disc herniation.Methods The data of 54 patients with lumbar disc herniation who were a-dopted from October 2009 to October 2012 were retrospectively analyzed.There were 32 males and 22 females, and the mean age was 42. 7 years (rang, 32-60 years).The level of surgery was L4/L5 in 34 patients,L5/S1 in 20 patients.All patients were divided into 2 groups according to the surgical methods, including 30 patients undergoing open transforaminal lumbar interbody fusion (OTLIF) and 24 patients undergoing minimally invasive transforaminal lumbar interbody fusion(MiTLIF).The operation time, intraoperative and postoperative blood loss, length of hospital-stay, intraoperative and postoperative complications were recorded .Intervertebral fusion rates 1 year after the operation were observed by radiographic data.Japanese Orthopaedic Association (JOA) scores were used for assessment.Results All patients were followed up for a mean period of 21.4 months (range, 12-36 months).In the MiTLIF group, the intraoperative andpostoperative blood loss was (40.2±15.6) mL, the length of hospital-stay was (6.2 ±2.4) d.Two weeks after the operation, the JOAscore was 18.7±1.9.In the OTLIF group, the intraoperative and postoperative blood loss was (203.6 ±52.8) mL, the length of hospital-stay was (10.8±4.2) d.Two weeks after the operation, the JOA score was 15.1 ±1.4.The difference between the 2 groups werestatistically significant (P <0.05).The differences in operation time, intraoperative and postoperative incidences of complications, JOAscores 1,3 and 12 months after the operation and lumbar fusion rates between the 2 groups were not statistically significant (P >0.05). Conclusion The MiTLIF has the advantages of less blood loss, shorter hospitalization time and rapid postoperative recovery in thetreatment of lumbar disc herniation with unilateral pedicle screw fixation.