CAJ | 학술논문

目的：对比Mast Quadrant微创系统下经椎间孔椎间融合术（ Mini-TLIF）与传统开放经椎间孔椎间融合术（ Open-TLIF）治疗腰椎滑脱症的临床疗效。方法回顾分析40例单节段腰椎滑脱症患者，Quad-rant后路微创撑开系统辅助下行经椎间孔椎间融合术20例为微创组，开放腰椎后路经椎间孔椎间融合术20例为开放组。收集患者围手术期的资料，包括切口长度、术中出血量、引流量、手术时间和术后下床活动时间等。对所有患者术前、术后2周、2个月、1年、2年进行VAS及ODI评分并记录。比较微创组与开放组患者之间的疗效。结果微创组在切口长度、出血量、术后下床活动时间等方面优于开放组，差异有统计学意义（P＜0.01）；但微创组手术时间长于开放组（ P＜0.05）。两组患者术后VAS、ODI评分均呈下降趋势，术后各时点评分与术前比较差异均具有统计学意义（ P＜0.01）。微创组术后VAS、ODI评分下降幅度较开放组下降幅度大，差异具有统计学意义（ P＜0.01）。术后2周VAS、ODI评分，微创组优于开放组（ P＜0.01）。结论 Mast Quadrant微创系统下经椎间孔椎间融合术与开放腰椎后路经椎间孔椎间融合术比较，具有切口小、术中及术后出血量少、术后下床活动时间早、短期临床疗效显著等优点。只要严格掌握手术适应证，该项微创技术值得临床推广。
목적：대비Mast Quadrant미창계통하경추간공추간융합술（ Mini-TLIF）여전통개방경추간공추간융합술（ Open-TLIF）치료요추활탈증적림상료효。방법회고분석40례단절단요추활탈증환자，Quad-rant후로미창탱개계통보조하행경추간공추간융합술20례위미창조，개방요추후로경추간공추간융합술20례위개방조。수집환자위수술기적자료，포괄절구장도、술중출혈량、인류량、수술시간화술후하상활동시간등。대소유환자술전、술후2주、2개월、1년、2년진행VAS급ODI평분병기록。비교미창조여개방조환자지간적료효。결과미창조재절구장도、출혈량、술후하상활동시간등방면우우개방조，차이유통계학의의（P＜0.01）；단미창조수술시간장우개방조（ P＜0.05）。량조환자술후VAS、ODI평분균정하강추세，술후각시점평분여술전비교차이균구유통계학의의（ P＜0.01）。미창조술후VAS、ODI평분하강폭도교개방조하강폭도대，차이구유통계학의의（ P＜0.01）。술후2주VAS、ODI평분，미창조우우개방조（ P＜0.01）。결론 Mast Quadrant미창계통하경추간공추간융합술여개방요추후로경추간공추간융합술비교，구유절구소、술중급술후출혈량소、술후하상활동시간조、단기림상료효현저등우점。지요엄격장악수술괄응증，해항미창기술치득림상추엄。
Objective To compare the clinical efficacy of transforaminal lumbar interbody fusion via Quad-rant minimally invasive system ( mini-TLIF ) versus traditional open transforaminal lumbar interbody fusion ( open-TILF) in the lumbar spine spondylolisthesis .Methods This was a retrospective review of collected data .Between January 2010 and January 2012 ,40 patients with low-grade spondylolisthesis were operated in our hospital ,20 patients underwent open-TILF and 20 patients underwent mini-TLIF.The blood loss, length of cut,operating time,postopera-tive bedrid time in the two groups were recorded perioperatively .Pain and functional disability were measured using visual analogue scale(VAS) and oswestry disability index(ODI) before operation,at 2 weeks,2 months,1 year and 2 years after operation .The therapeutic effects were compared between two groups after operations .Results In aspect of the blood loss,length of cut,postoperative bedrid time,the mini-TLIF group was better(P<0.01),while the open-TILF group was better in the operating time ( P<0.05 ) .Postoperative VAS and ODI scores in two groups were decli-ning after operation ,each point scores were statistically significant difference ( P<0.01 ) compared with preoperative scores.The postoperative VAS and ODI scores in mini-TLIF group decreased more markedly than those in the open-TILF group,the difference was statistically significant (P<0.01).The scores of VAS and ODI of mini-TLIF group were less than those in open-TILF group at 2 weeks and 2 months after operation ( P<0.01 ) .Conclusion The trans-foraminal lumbar interbody fusion operation by Quadrant system to treat the patients with lumbar spondylolisthesis is more simple and efficient than open TILF .It has advantages in the blood loss , length of cut , postoperative bedrid time and the short-term postoperative pain .Provided strictly master the operation indications ,it is worth to be promoted .