CAJ | 학술논문

目的分析双侧椎旁Wiltse间隙入路微创经椎间孔椎体间融合(MIS-TLIF)治疗腰椎滑脱的疗效.方法 2012年5月至2013年11月期间收治13例Ⅰ～Ⅱ°腰椎滑脱患者,均在神经电生理监测和显微镜下,采用双侧椎旁Wiltse间隙(多裂肌与最长肌间隙)入路MIS-TLIF治疗.分析本组手术时间、出血量、术后局部伤口疼痛时间和术后腰腿痛缓解时间;记录术前、术后1、3、7d肌酸磷酸激酶(CPK-MM)水平;分析术前、术后1周、3个月和6个月的日本骨科学会(JOA)评分和疼痛视觉模拟量表(VAS)评分;通过术前、术后1周、术后6个月的腰椎正侧位片和腰椎MRI平扫评估滑脱复位和神经减压情况;于术后1周行腰椎CT三维重建检查椎弓根置入情况及脊柱稳定性.结果本组病例手术顺利,无神经损伤病例.手术出血量为(185.3±26.3)ml,手术时间为(186.0±23.0)min.术后腰椎正侧位片和腰椎MRI平扫显示滑脱复位良好,神经减压充分;术后腰椎CT三维重建提示椎弓根置入位置准确,未出现脊柱不稳.VAS及JOA评分在术后1周、3个月和6个月均较术前明显改善(P＜0.05).CPK-MM水平于术后1d达到高峰,随后逐渐降低,于术后7d恢复至接近术前水平.结论 MIS-TLIF在手术时间、术中出血量、椎旁肌保护及临床症状改善等方面,具有明显优势.显微镜及神经电生理辅助下,双侧椎旁Wiltse间隙入路MIS-TLIF治疗腰椎滑脱,安全可行且疗效显著.
목적 분석쌍측추방Wiltse간극입로미창경추간공추체간융합(MIS-TLIF)치료요추활탈적료효.방법 2012년5월지2013년11월기간수치13례Ⅰ～Ⅱ°요추활탈환자,균재신경전생리감측화현미경하,채용쌍측추방Wiltse간극(다렬기여최장기간극)입로MIS-TLIF치료.분석본조수술시간、출혈량、술후국부상구동통시간화술후요퇴통완해시간;기록술전、술후1、3、7d기산린산격매(CPK-MM)수평;분석술전、술후1주、3개월화6개월적일본골과학회(JOA)평분화동통시각모의량표(VAS)평분;통과술전、술후1주、술후6개월적요추정측위편화요추MRI평소평고활탈복위화신경감압정황;우술후1주행요추CT삼유중건검사추궁근치입정황급척주은정성.결과 본조병례수술순리,무신경손상병례.수술출혈량위(185.3±26.3)ml,수술시간위(186.0±23.0)min.술후요추정측위편화요추MRI평소현시활탈복위량호,신경감압충분;술후요추CT삼유중건제시추궁근치입위치준학,미출현척주불은.VAS급JOA평분재술후1주、3개월화6개월균교술전명현개선(P＜0.05).CPK-MM수평우술후1d체도고봉,수후축점강저,우술후7d회복지접근술전수평.결론 MIS-TLIF재수술시간、술중출혈량、추방기보호급림상증상개선등방면,구유명현우세.현미경급신경전생리보조하,쌍측추방Wiltse간극입로MIS-TLIF치료요추활탈,안전가행차료효현저.
Objective To analyze microsurgical treatment of minimally invasive transforaminal interbody fusion (MIS-TLIF) through bilateral Wiltse approach for spondylolisthesis.Methods Between May 2012 and November 2013,13 patients diagnosed lumbar spondylolisthesis (Myerding Grade Ⅰ-Ⅱ) were included.With the assistant of neurophysiological monitoring and microscope,all patients were treated by MIS-TLIF through bilateral Wiltse approach (gap between the multifidus and the longissimus).Operation time,blood loss,postoperative wound pain duration and Lumbocrural pain relief time were analyzed.Creatine phosphokinase (CPK-MM) level was recorded preoperatively,1 day,3 days and 7 days postoperatively.Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were analyzed preoperatively,1 week,3 months and 6 months postoperatively.X-ray examination and MR imaging of lumbar spine were achieved preoperatively and 6 months postoperatively to assess slippage reset and nerve decompression.Lumbar CT three-dimensional reconstruction was used to confirm pedicle placement and spinal stability.Results All patients accepted successful operation without nerve injury.The blood loss was (185.3 ±26.3) ml,and operating time was (186.0 ±23.0) min.Postoperative lumbar X-ray examination and MRI scan demonstrated good slippage reset and complete nerve decompression.Postoperative lumbar CT three dimensional reconstruction showed accurate pedicle placement and good spinal stability.VAS,JOA score obviously improved in postoperative 1 week,3 months and 6 months compared with that before operation(P ＜0.05).CPK-MM level peaked at postoperative 1 day,then gradually reduced,and almost descended to preoperative level at postoperative 7 day.Conclusions MIS-TLIF technique has obvious advantages over operating time,blood loss,paraspinal muscle protection and improvement of clinical symptoms.It is feasible and clinically effective of MIS-TLIF through bilateral Wiltse approach for lumbar spondylolisthesis with the assistance of microscope and neurophysiological monitoring.