CAJ | 학술논문

目的探讨腰椎后路单侧椎弓根螺钉联合椎体间融合器(Cage)选择性治疗退行性腰椎病的临床疗效.方法分析49例腰椎退行性疾病患者,术前影像学资料明确患者存在椎间盘突出和(或)单侧侧隐窝狭窄,临床表现以下腰部疼痛为主,伴或不伴一侧肢体麻木疼痛症状,经保守治疗无效后,采用经后路单侧椎弓根螺钉内固定联合Cage椎间植骨融合手术进行治疗,其中男24例,女25例,年龄26 ～ 75岁(平均54.2岁),病程0.5 ～3.0年.使用Oswestry(ODI)功能障碍指数和日本骨科协会(JOA)评分法评估术后疗效,依据SUK法对术后脊柱融合情况进行评估.结果所有患者手术前后Oswestry功能障碍指数之间比较差异有统计学意义(P＜0.05),根据日本JOA评分法评估优36例(73.4％)、良9例(18.4％)、可2例(4.1％)、差2例(4.1％),依据SUK标准证实本组病例椎体间植骨融合率为91.8％.有2例患者术后复查出现内固定螺钉螺栓松脱,但内固定椎弓根钉无松动断裂脱出,经调整更换尾帽并行支具固定3个月后复查未见松动,患者肢体症状均明显改善.结论单侧椎弓根钉联合Cage椎体间融合选择性治疗退行性腰椎病手术时间短、创伤小、临床疗效良好.
목적 탐토요추후로단측추궁근라정연합추체간융합기(Cage)선택성치료퇴행성요추병적림상료효.방법 분석49례요추퇴행성질병환자,술전영상학자료명학환자존재추간반돌출화(혹)단측측은와협착,림상표현이하요부동통위주,반혹불반일측지체마목동통증상,경보수치료무효후,채용경후로단측추궁근라정내고정연합Cage추간식골융합수술진행치료,기중남24례,녀25례,년령26 ～ 75세(평균54.2세),병정0.5 ～3.0년.사용Oswestry(ODI)공능장애지수화일본골과협회(JOA)평분법평고술후료효,의거SUK법대술후척주융합정황진행평고.결과 소유환자수술전후Oswestry공능장애지수지간비교차이유통계학의의(P＜0.05),근거일본JOA평분법평고우36례(73.4％)、량9례(18.4％)、가2례(4.1％)、차2례(4.1％),의거SUK표준증실본조병례추체간식골융합솔위91.8％.유2례환자술후복사출현내고정라정라전송탈,단내고정추궁근정무송동단렬탈출,경조정경환미모병행지구고정3개월후복사미견송동,환자지체증상균명현개선.결론 단측추궁근정연합Cage추체간융합선택성치료퇴행성요추병수술시간단、창상소、림상료효량호.
Objective To investigate the curative effectinvess of the lumbar posterior unilateral pedicle screw with cage fusion between vertebre in selective treatment of degenerative lumbar disease.Methods Forty-nine patients with lumbar degenerative disease,preoperative imaging data verified that patients with Intervertebral disc herniation and (or) unilateral lateral recess stenosis,and clinical manifestations mostly were waist pain,with or without symptoms of one side numbness and pain,after conservative treatment is invalid,utilized surgery treatment of the posterior unilateral pedicle screws fixation with cage of intervertebral bone graft fusion,24 cases of men,women,25 cases,aged 26 to 75 years old (average 54.2 years),0.5-3.0 years duration of the disease.Use Oswestry index (ODI) dysfunction and Japanese Orthopaedic Association (JOA) score method to evaluate the postoperative curative effect,on the basis of SUK method to evaluate the postoperative spinal fusion.Results The difference of preoperative and postoperative Oswestry disability index of all patients was statistically significant,according to Japanese JOA score method,optimal effect were 36 cases (73.4％),well effect were 9 cases (18.4％),ordinary effect were 2 cases (4.1％),poor effect were 2 cases (4.1％),according to the SUK standard confirmed that vertebral body bone graft fusion rate was 91.8％.2 patients appeared postoperative review set screw bolts loose,but internal fixation of pedicle screw without loose or breaking out,adjusted to replace the tail cap in parallel and with a fixed march did not appear loose again,the limb symptoms were significantly improved.Conclusion Unilateral pedicle screw with Cage fusion between vertebral in selective treatment of degenerative lumbar disease has the advantage of shorter operation time,less trauma,and well clinical curative effect.