CAJ | 학술논문

目的：比较微创（Minimally invasive，MIS)与常规开放椎弓根螺钉联合经椎间孔椎间融合术(TLIF)治疗单间隙腰椎退行性疾病的中长期疗效。方法回顾性分析单间隙腰椎退行性疾病患者92例，其中微创组47例，开放组45例，微创组均采用可扩张通道(Quadrant)和经皮椎弓根螺钉(Sextant)技术。比较两种手术方式的手术时间、术中出血量、透视次数、术后下床活动时间、住院时间以及相关并发症。采用视觉模拟评分（VAS）评估患者术前、末次随访时疼痛情况，Oswestry功能障碍指数评分(ODI)评价疗效，通过影像学测量不同部位椎间隙高度，并评估末次随访时椎体间融合情况及远期并发症。结果所有患者随访4~7年，平均5.3年。术中出血量、术后下床活动时间和住院时间微创组较开放组明显减少（P<0.05)，手术时间及透视次数微创组较开放组延长(P<0.05)。两组患者术后VAS及ODI评分均较术前有明显改善（P<0.05)，两组间术前及末次随访时VAS及ODI评分的差异无统计学意义(P>0.05)。微创组与开放组在手术前后不同部位椎间隙高度差异无统计学意义（P>0.05），但末次随访时椎间隙高度均较术前改善，且差异具有统计学意义(P<0.05)。融合率微创组与开放组无显著差异(P>0.05)。影像学检查结果显示相邻节段退变发生率微创组较开放组降低(P<0.05)。随访期间两组均未发现继发性脊柱侧弯，Cage移位及螺钉松动、断裂等并发症发生。结论与开放手术相比较，微创组具有减少术中出血量，缩短下床活动时间和住院时间，降低相邻节段退变发生率的优点，但需要较长的手术时间及术者接受较多的放射线暴露。微创与常规开放椎弓根螺钉联合经椎间孔椎间融合术治疗腰椎退行性疾病均能获得满意的长期疗效。
목적：비교미창（Minimally invasive，MIS)여상규개방추궁근라정연합경추간공추간융합술(TLIF)치료단간극요추퇴행성질병적중장기료효。방법회고성분석단간극요추퇴행성질병환자92례，기중미창조47례，개방조45례，미창조균채용가확장통도(Quadrant)화경피추궁근라정(Sextant)기술。비교량충수술방식적수술시간、술중출혈량、투시차수、술후하상활동시간、주원시간이급상관병발증。채용시각모의평분（VAS）평고환자술전、말차수방시동통정황，Oswestry공능장애지수평분(ODI)평개료효，통과영상학측량불동부위추간극고도，병평고말차수방시추체간융합정황급원기병발증。결과소유환자수방4~7년，평균5.3년。술중출혈량、술후하상활동시간화주원시간미창조교개방조명현감소（P<0.05)，수술시간급투시차수미창조교개방조연장(P<0.05)。량조환자술후VAS급ODI평분균교술전유명현개선（P<0.05)，량조간술전급말차수방시VAS급ODI평분적차이무통계학의의(P>0.05)。미창조여개방조재수술전후불동부위추간극고도차이무통계학의의（P>0.05），단말차수방시추간극고도균교술전개선，차차이구유통계학의의(P<0.05)。융합솔미창조여개방조무현저차이(P>0.05)。영상학검사결과현시상린절단퇴변발생솔미창조교개방조강저(P<0.05)。수방기간량조균미발현계발성척주측만，Cage이위급라정송동、단렬등병발증발생。결론여개방수술상비교，미창조구유감소술중출혈량，축단하상활동시간화주원시간，강저상린절단퇴변발생솔적우점，단수요교장적수술시간급술자접수교다적방사선폭로。미창여상규개방추궁근라정연합경추간공추간융합술치료요추퇴행성질병균능획득만의적장기료효。
Objective To investigate the mid-and long-term clinical outcomes of minimally invasive (MIS) versus open transforaminal lumbar in-terbody fusion (TLIF) in treatment of one-level lumbar degenerative disease. Methods 92 patients with one-level lumbar degenerative disease underwent surgical intervention were retrospectively analyzed, 47patients in MIS-TLIF group and 45 patients in open-TLIF group. MIS-TLIF was done by using ex-pandable working tubes (Quadrant) and percutaneous pedicle screws (Sextant). Operative time, intra-operative bleeding, radiation exposure time, time to re-sume early activity, hospital time and general complications were recorded. Postsurgical pain and functional results were analyzed by the visual analog scale (VAS) and Oswestry Disability Index (ODI). Radiological examination was obtained to assess the height of intervertebral space, postoperative intervertebral fusion conditions and long term complications. Results The mean follow-up was 5.3 years, with a range of 4 to 7 years. The group of MIS-TLIF was su-perior to the group of open-TLIF in intra-operative bleeding, time to resume early activity, hospital time ( P<0.05). The group of MIS-TLIF need more opera-tion time and were exposed to more X-ray compared to the open-TLIF group ( P<0.05). The most frequently used methods to assess the clinical function were visual analog VAS scores and ODI scores. The ODI and VAS scores post-operation improved significantly in each group ( P<0.05), but showed no significant difference between the 2 groups at pre-operation and last follow-up ( P>0.05). No statistical difference of each patient to assess the height of intervertebral space between preoperation and final follow-up for each group was noted ( P>0.05), but the postoperative radiologic indexes of all patients were higher than the preoperative ones (P<0.05).The fusion rate was no significant difference between the two groups ( P>0.05). The MIS-TLIF group was associated with significantly reduced the incidence of the adjacent segment disease ( P<0.05). There were no complications such as secondary scoliosis, intervertebral altitude loss, cage slippage, screw loosening and internal fixation failure during the follow-up period. Conclusion MIS-TLIF was superior to open-TLIF in in-tra-operative bleeding, time to resume early activity, hospital time, reduced the incidence of the adjacent segment disease, but it needs more operation time and radiation exposure . MIS-TLIF and open-TLIF can both get satisfactory mid-and long-term clinical outcomes in treatment of one-level lumbar degen-erative disease.