CAJ | 학술논문

目的：探讨采用PIPELINE可扩张微创通道管系统结合VIPER2经皮椎弓根螺钉固定技术治疗腰椎退行性疾病的疗效。方法收集2012年2月至2013年12月采用PIPELINE微创通道减压融合结合VIPER2经皮椎弓根螺钉固定治疗，并获得随访32例腰椎退变疾病患者的临床资料。均采用后路中央两旁多裂肌间隙入路，在PIPELINE可扩张通道微创系统下行椎管减压、椎间融合并联合VIPER2经皮椎弓根螺钉内固定技术。采用VAS疼痛评分和Oswestry功能障碍指数（Os-westry disabi-lity index，ODI）评分评估临床疗效，并观察术前、术后各项指标及并发症情况。结果所有患者随访时间平均为8.3个月。统计分析显示术后1周及末次随访时的腰腿痛VAS评分和ODI评分与术前相比明显改善。差异有统计学意义（P<0.05）。末次随访时生活质量改善率平均为85%。32例患者的平均手术时间为122min。平均手术切口长度为5.3cm。术中平均出血0.18L，术后平均引流量为0.085L。出现并发症3例，均为切口表皮坏死，经换药后Ⅰ期愈合。结论 PIPELINE微创通道结合VIPER2经皮椎弓根螺钉技术治疗腰椎退变性疾病具有对组织损伤轻、出血少、术后恢复快、近期疗效肯定等优点，是一种安全、有效并且可靠的微创手术方法。
목적：탐토채용PIPELINE가확장미창통도관계통결합VIPER2경피추궁근라정고정기술치료요추퇴행성질병적료효。방법수집2012년2월지2013년12월채용PIPELINE미창통도감압융합결합VIPER2경피추궁근라정고정치료，병획득수방32례요추퇴변질병환자적림상자료。균채용후로중앙량방다렬기간극입로，재PIPELINE가확장통도미창계통하행추관감압、추간융합병연합VIPER2경피추궁근라정내고정기술。채용VAS동통평분화Oswestry공능장애지수（Os-westry disabi-lity index，ODI）평분평고림상료효，병관찰술전、술후각항지표급병발증정황。결과소유환자수방시간평균위8.3개월。통계분석현시술후1주급말차수방시적요퇴통VAS평분화ODI평분여술전상비명현개선。차이유통계학의의（P<0.05）。말차수방시생활질량개선솔평균위85%。32례환자적평균수술시간위122min。평균수술절구장도위5.3cm。술중평균출혈0.18L，술후평균인류량위0.085L。출현병발증3례，균위절구표피배사，경환약후Ⅰ기유합。결론 PIPELINE미창통도결합VIPER2경피추궁근라정기술치료요추퇴변성질병구유대조직손상경、출혈소、술후회복쾌、근기료효긍정등우점，시일충안전、유효병차가고적미창수술방법。
Objective To study the curative effects of PIPELINE Expandable Access System in combination with VIPER2 percutaneous pedicle screw fixation on lumbar degenerative diseases. Methods The clinical data of 32 patients with lumbar de-generative diseases were collected,who received PIPELINE minimally invasive access decompression and fusion in combination with VIPER2 percutaneous pedicle screw fixation for treatment from February 2012 to December 2013 ,and follow-up was per-formed for all the patients. Posterior paramedian transmultifidus approach was adopted for all the patients ,spinal decompression and interbody fusion by PIPELINE Expandable Access System in combination with VIPER2 percutaneous pedicle screw fixation were performed. The visual analogue scale (VAS) pain score and Oswestry disability index (ODI) were adopted for the assessment of clinical effects. Complications as well as preoperative and postoperative indicators were observed. Results The average follow-up time of all the patients was 8.3 months. Statistical analysis showed that the VAS score for lumbocrural pain and ODI score at 1 week after operation and the last follow-up visit were remarkably improved compared with those before operation ,and the differ-ence was statistically significant(P<0.05). The improvement rate of the quality of life at the last follow-up visit was 85%. The aver-age duration of operation was 122 minutes. The average length of incision was 5.3cm. The average intraoperative bleeding volume was 0.18L and the average postoperative drainage volume was 0.085L. As for the postoperative complications ,epidermal necrosis of incision was observed in 3 cases,which achieved healing by primary intention after dressing change. Conclusion PIPELINE mini-mally invasive access in combination with VIPER2 percutaneous pedicle screw fixation has advantages such as mild tissue dam-age,less bleeding,fast postoperative recovery and definite short-term effects in the treatment of lumbar degenerative diseases. It is a minimally invasive surgery with high safety,effectiveness and reliability.