CAJ | 학술논문

目的：目前对K-Rod椎弓根动态固定系统治疗腰椎极外侧间盘突出合并多节段腰椎退变的文献报道甚少。文中比较分析K-Rod椎弓根动态稳定系统与传统腰椎融合方法在治疗腰椎极外侧间盘突出多节段腰椎退变的近期临床疗效。方法回顾性收集2010年1月至2012年10月期间沈阳军区总医院56例接受腰椎极外侧间盘突出合并多节段腰椎退变手术的患者资料。根据治疗方法不同分为K-Rod组（融合辅助以相邻退变节段非融合）和传统融合组。其中K-Rod组28例患者行K-Rod椎弓根动态稳定系统内固定术，传统融合组28例患者行传统腰椎融合内固定术。通过分析比较2组手术前后Oswestry功能评分、目测类比评分、术后腰椎X线片、手术时间、术中失血量、术后平均住院日等指标，评估2种技术对于治疗腰椎极外侧间盘突出多节段腰椎退变的近期疗效。结果2组共56例患者获得12～24个月随访。患者治疗后12个月Oswestry功能与目测类比评分均较治疗前有明显改善，差异有统计学意义（ P＜0．05）。2组组间术前及术后12个月分别比较，Oswestry功能评分与目测类比评分差异无统计学意义（P＞0．05），但K-Rod组与传统融合组在平均手术时间[（119．6±14．2）min vs （155．5±17．5）min]、平均失血量[（235．5±32．5）mL vs （367．5±29．5）mL]以及术后平均住院时间[（10．5±2．2）d vs （14．2±2．6）d]比较差异有统计学意义（P＜0．05）。结论 K-Rod椎弓根动态稳定系统较传统腰椎融合在治疗多节段腰椎退行性疾病具有术中失血少、手术时间短、术后对腰椎活动度影响小等优点。
목적：목전대K-Rod추궁근동태고정계통치료요추겁외측간반돌출합병다절단요추퇴변적문헌보도심소。문중비교분석K-Rod추궁근동태은정계통여전통요추융합방법재치료요추겁외측간반돌출다절단요추퇴변적근기림상료효。방법회고성수집2010년1월지2012년10월기간침양군구총의원56례접수요추겁외측간반돌출합병다절단요추퇴변수술적환자자료。근거치료방법불동분위K-Rod조（융합보조이상린퇴변절단비융합）화전통융합조。기중K-Rod조28례환자행K-Rod추궁근동태은정계통내고정술，전통융합조28례환자행전통요추융합내고정술。통과분석비교2조수술전후Oswestry공능평분、목측류비평분、술후요추X선편、수술시간、술중실혈량、술후평균주원일등지표，평고2충기술대우치료요추겁외측간반돌출다절단요추퇴변적근기료효。결과2조공56례환자획득12～24개월수방。환자치료후12개월Oswestry공능여목측류비평분균교치료전유명현개선，차이유통계학의의（ P＜0．05）。2조조간술전급술후12개월분별비교，Oswestry공능평분여목측류비평분차이무통계학의의（P＞0．05），단K-Rod조여전통융합조재평균수술시간[（119．6±14．2）min vs （155．5±17．5）min]、평균실혈량[（235．5±32．5）mL vs （367．5±29．5）mL]이급술후평균주원시간[（10．5±2．2）d vs （14．2±2．6）d]비교차이유통계학의의（P＜0．05）。결론 K-Rod추궁근동태은정계통교전통요추융합재치료다절단요추퇴행성질병구유술중실혈소、수술시간단、술후대요추활동도영향소등우점。
Objective Currently there is little study on the K-Rod pedicle fixation system in the treatment of far lateral lum-ber disc hernaition with multiple segment degeneration.The study was to compare the short-term efficay of K-Rod pedicle dynamic fixa-tion system and lumbar fusion for far lateral lumber disc herniation with multiple segment degeneration. Methods Retrospective a-nalysis were made on 56 patients with lumbar intervertebral disc herniation with multiple segment degeneration who received operation in General Hospital of Shenyang Military Region from January 2010 to October 2012.They were divided into K-Rod group (combined treatment of lumbar fusion and adjacent degenerative segment unfusion) and traditional fusion group according to different treatments. 28 patients in K-Rod group were treated with K-Rod pedicle dynamic fixation system and 28 cases in traditional fusion group were trea-ted with traditional lumbar fusion and internal fixation.Comparative analysis were made on the indexes before and after operation be-tween two groups, including Oswestry disability index, visual analogous scale (VAS) ,improvement rate of low back pain, postopera-tive lumbar spine X-ray, operation time, intraoperative blood loss and postoperative average length of stay. Results 12 to 24 months follow-up were achieved on 56 cases.The Oswestry function score and visual analog scale for both groups were improved significantly at 12 months after operation, and the difference was of statistical significance (P<0.05).Oswestry function scores and vis-ual analog scales between two groups were of no significant difference either before operation or after operation (P>0.05), while the average operation time ([119.6 ±14.2] min vs [155.5 ±17.5]min), the average blood loss ([235.5 ±32.5] mL vs [367.5 ±29. 5] mL), the average length of stay (ALOS) ([10.5 ±2.2] vs [14.2 ±2.6]d) between K-Rod group and traditional fusion group were of significant difference(P<0.05). Conclusion In the treatment of far lateral lumber disc hernaition with multiple segment degeneration, the K-Rod pedicle dynamic fixation system atrributes to less intraoperative blood loss, shorter operation time and little postoperative effect on lumbar spine mobility.