CAJ | 학술논문

目的对比小切口与传统开放术式进行单节段后路腰椎椎体间融合(posterior lumbar interbody fusion,PLIF)术对脊旁肌损伤程度的差别.方法 2006年3月至2008年5月,应用PLIF术治疗单节段下腰椎病变患者91例.小切口组41例,男22例,女19例;年龄34～72岁,平均53.5岁;椎间盘突出伴椎间隙狭窄10例、椎管狭窄症7例、椎体后缘离断症4例、腰椎滑脱症20例.开放组50例,男23例,女27例;年龄28～75岁,平均53.4岁;椎问盘突出伴椎间隙狭窄13例、椎管狭窄症8例、椎体后缘离断症4例、腰椎滑脱症25例.比较两组病例的手术时间、术中出血及术前、术后第1、3、5、7天的肌酸激酶水平.对术后1年以上患者评估VAS疼痛评分和Oswestry功能障碍评分.分别对11例小切口和10例开放手术的患者手术节段水平多裂肌横截面积比较.结果小切口组术中出血及术后第1、3、5无肌酸激酶水平明显低于开放组.小切口组25例、开放组30例获得随访.VAS分值和ODI百分数两组患者术前均无明显差别,而术后小切口组均明显低于开放组.小切口组术后多裂肌横截面积尢明显变化,脂肪化轻微;而开放组多裂肌萎缩明显,并且瘢痕化、脂肪化明显.结论与传统PLIF术相比,小切口PLIF术具有切口小、术中出血少、软组织损伤小、术后恢复快、多裂肌萎缩和腰背痛的发生率低等优点.
목적 대비소절구여전통개방술식진행단절단후로요추추체간융합(posterior lumbar interbody fusion,PLIF)술대척방기손상정도적차별.방법 2006년3월지2008년5월,응용PLIF술치료단절단하요추병변환자91례.소절구조41례,남22례,녀19례;년령34～72세,평균53.5세;추간반돌출반추간극협착10례、추관협착증7례、추체후연리단증4례、요추활탈증20례.개방조50례,남23례,녀27례;년령28～75세,평균53.4세;추문반돌출반추간극협착13례、추관협착증8례、추체후연리단증4례、요추활탈증25례.비교량조병례적수술시간、술중출혈급술전、술후제1、3、5、7천적기산격매수평.대술후1년이상환자평고VAS동통평분화Oswestry공능장애평분.분별대11례소절구화10례개방수술적환자수술절단수평다렬기횡절면적비교.결과 소절구조술중출혈급술후제1、3、5무기산격매수평명현저우개방조.소절구조25례、개방조30례획득수방.VAS분치화ODI백분수량조환자술전균무명현차별,이술후소절구조균명현저우개방조.소절구조술후다렬기횡절면적왕명현변화,지방화경미;이개방조다렬기위축명현,병차반흔화、지방화명현.결론 여전통PLIF술상비,소절구PLIF술구유절구소、술중출혈소、연조직손상소、술후회복쾌、다렬기위축화요배통적발생솔저등우점.
Objective To determine the differences of paraspinal muscle injury between the minimally invasive and conventional open approach for one-level instrumented posterior lumbar interbody fusion (PLIF).Methods From March 2006 to May 2008,91 patients underwent one.1cvel instrumented PLIF procedure using 2 different approaches(minimally invasive approach in 41 patients and open approach in 50 patients)by one group of surgeons.The following data were compared between the 2 groups:surgical time,blood loss,changes of postoperative serum level of Creatinine Kinase.More than 1 year after operation.the patients were followed up with VAS scores and Oswestry disability questionnaire.Some patients aceepted MRI evaluation by comparing the cross section area and fat degeneration grades at the operative level between pre-operation and post-operation.Results There was no obvious difference in surgical time,but less blood loss,lower index of serum level of Creatinine Kinase,less postoperative back pain,and lower ODI percent in minimally invasive group.There was significant decrease in the cross sectional area of multifidus muscle in the conventional group.In contrast,the results in the minimally invasive group showed no statistical differcnce between preoperative results and that of the follow-up MRl.Conclusion Comparert with conventional approach,minimally invasive approach PLIF can get smaller approach,less blood loss and soff tissue injury,faster recovery posteroperatively,and less incidence of multifidus atrophy and low back pain.