CAJ | 학술논문

目的：比较单边和双边椎弓根内固定加椎间融合器治疗单节段腰椎退变性疾病的临床疗效和影像学改变。方法2009年5月～2011年12月，回顾性研究84例单节段腰椎退变并接受单边或双边椎弓根内固定加椎间融合术的患者。分别统计比较2组患者出血量、手术时间、住院时间、植骨融合率、并发症发生率和内置物费用。术前和术后用疼痛视觉模拟量表（ visual analogue scale ， VAS）评分、Oswestry功能障碍指数（ Oswestry disability index ， ODI）和日本骨科学会（ Japanese Orthopaedic Association ，JOA）评分来评估2组患者的临床效果。融合节段平均椎间隙高度、腰椎前凸角和腰椎侧凸角用来评估2组患者的影像学结果。结果术后平均随访24．5个月。2组患者之间的植骨融合率和并发症发生率比较差异没有统计学意义（P＞0．05），但单边组的手术时间、出血量和内置物费用明显少于双边组，差异有统计学意义（ P＜0．05）。2组内术后VAS评分、ODI和下腰痛JOA评分与术前比较差异有统计学意义（ P＜0．05），但末次随访与术后12个月的各评分比较差异无统计学意义（P＞0．05）。术后2组患者融合节段平均椎间高度和腰椎前凸角较术前明显改善（P＜0．05），腰椎侧凸角则无明显变化（P＞0．05）。2组共有2例硬膜囊破裂，3例术后浅表伤口感染。所有患者均未出现钉棒断裂及融合器脱出情况。结论单边椎弓根内固定加椎间融合术治疗单节段腰椎退变患者可以达到较满意的临床效果。
목적：비교단변화쌍변추궁근내고정가추간융합기치료단절단요추퇴변성질병적림상료효화영상학개변。방법2009년5월～2011년12월，회고성연구84례단절단요추퇴변병접수단변혹쌍변추궁근내고정가추간융합술적환자。분별통계비교2조환자출혈량、수술시간、주원시간、식골융합솔、병발증발생솔화내치물비용。술전화술후용동통시각모의량표（ visual analogue scale ， VAS）평분、Oswestry공능장애지수（ Oswestry disability index ， ODI）화일본골과학회（ Japanese Orthopaedic Association ，JOA）평분래평고2조환자적림상효과。융합절단평균추간극고도、요추전철각화요추측철각용래평고2조환자적영상학결과。결과술후평균수방24．5개월。2조환자지간적식골융합솔화병발증발생솔비교차이몰유통계학의의（P＞0．05），단단변조적수술시간、출혈량화내치물비용명현소우쌍변조，차이유통계학의의（ P＜0．05）。2조내술후VAS평분、ODI화하요통JOA평분여술전비교차이유통계학의의（ P＜0．05），단말차수방여술후12개월적각평분비교차이무통계학의의（P＞0．05）。술후2조환자융합절단평균추간고도화요추전철각교술전명현개선（P＜0．05），요추측철각칙무명현변화（P＞0．05）。2조공유2례경막낭파렬，3례술후천표상구감염。소유환자균미출현정봉단렬급융합기탈출정황。결론단변추궁근내고정가추간융합술치료단절단요추퇴변환자가이체도교만의적림상효과。
Objective To evaluate clinical and radiological outcomes of unilateral versus bilateral pedicle screw fixation with interbody fusion in the treatment of single-level degenerative lumbar disorders.Methods From May 2009 to December 2011,84 consecutive patients suffered from single-level lumbar degenerative diseases were treated with unilateral or bilateral pedicle screw fix-ation with interbody fusion.Blood loss, operative time,duration of hospital stay, fusion rate, complication rate,implant costs were recorded and analysed statistically.The clinical outcomes of 2 groups were assessed by visual analog scale (VAS) scores、Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) scores.Mean disc space height of fused segements,the whole lumbar lordotic angle and lumbar scoliosis angle were analyzed for radiological assessment preoperatively and postoperatively . Results Mean follow-up time was 24.5 months.No statistical significance was observed in terms of fusion rate and complication rate between 2 groups(P>0.05),whereas operative time, blood loss and implant costs of unilateral group reduced significantly com-pared with bilateral fixation group(P<0.05).In addition, statistical significance was found with respect to postoperative scores of VAS scores,ODI and JOA scores compared with preoperative data (P<0.05),whereas no statistical significance between the final follow-up and 12 months follow-up in the same group(P>0.05).Postoperative lumbar lordotic angle and mean disc space height of fused segements increased obviously when compared with preoperative data (P<0.05),whereas no significant difference found in terms of lumbar scoliosis angle(P>0.05)in each group.Two cases of laceration of the dural sac and 3 cases of superficial wound infection occurred.Both groups didn’t have device-related complications such as pedicle screw loosening、breakage and cage malpo-sition.Conclusion Clinical efficacy of unilateral pedicle screw fixation with interbody fusion in the treatment of single-level lumbar degenerative disorders was satisfying.