CAJ | 학술논문

目的：比较MIS-TLIF单侧和双侧椎弓根螺钉固定治疗腰椎间盘突出症的临床效果。方法46例腰椎间盘突出症患者分别采用MIS-TLIF单侧椎弓根螺钉固定(单侧固定组,18例)和双侧椎弓根螺钉固定(双侧固定组,28例),采用VAS评分及ODI评分评估手术疗效。结果手术时间：单侧固定组为90~160(115±14．5) min,双侧固定组130~220(160±17．2) min,差异有统计学意义(P<0．05)。术中出血量：单侧固定组为210~450(300±41．8) ml,双侧固定组为300~600(420±56．3)ml,差异有统计学意义(P<0．05)。患者均获得随访,单侧固定组随访15~31(25．2 ±5．1)个月,双侧固定组随访16~34(26．4±5．6)个月。 VAS评分：单侧固定组术前为6．0分±1．2分,术后为2．1分±1．1分,术后1年为2．0分±1．2分；双侧固定组术前为5．9分±1．6分,术后为2．0分±0．8分,术后1年2．1分±0．7分。 ODI评分：单侧固定组术前为43．0分±1．9分,术后为15．0分±2．8分,术后1年14．0分±1．9分；双侧固定组术前为42．0分±2．1分,术后为13．0分±1．9分,术后1年12．0分±1．8分。两组两项评分术后与术前比较差异均有统计学意义(P<0．05),组间比较差异均无统计学意义(P>0.05)。两组均椎间植骨融合良好,无内固定松动、断裂及融合器移位等情况。结论 MIS-TLIF单侧椎弓根螺钉固定加单枚cage植入术治疗腰椎间盘突出症可以获得与双侧固定相同的临床疗效,且具有手术时间短、术中出血量少、组织损伤轻等优点。
목적：비교MIS-TLIF단측화쌍측추궁근라정고정치료요추간반돌출증적림상효과。방법46례요추간반돌출증환자분별채용MIS-TLIF단측추궁근라정고정(단측고정조,18례)화쌍측추궁근라정고정(쌍측고정조,28례),채용VAS평분급ODI평분평고수술료효。결과수술시간：단측고정조위90~160(115±14．5) min,쌍측고정조130~220(160±17．2) min,차이유통계학의의(P<0．05)。술중출혈량：단측고정조위210~450(300±41．8) ml,쌍측고정조위300~600(420±56．3)ml,차이유통계학의의(P<0．05)。환자균획득수방,단측고정조수방15~31(25．2 ±5．1)개월,쌍측고정조수방16~34(26．4±5．6)개월。 VAS평분：단측고정조술전위6．0분±1．2분,술후위2．1분±1．1분,술후1년위2．0분±1．2분；쌍측고정조술전위5．9분±1．6분,술후위2．0분±0．8분,술후1년2．1분±0．7분。 ODI평분：단측고정조술전위43．0분±1．9분,술후위15．0분±2．8분,술후1년14．0분±1．9분；쌍측고정조술전위42．0분±2．1분,술후위13．0분±1．9분,술후1년12．0분±1．8분。량조량항평분술후여술전비교차이균유통계학의의(P<0．05),조간비교차이균무통계학의의(P>0.05)。량조균추간식골융합량호,무내고정송동、단렬급융합기이위등정황。결론 MIS-TLIF단측추궁근라정고정가단매cage식입술치료요추간반돌출증가이획득여쌍측고정상동적림상료효,차구유수술시간단、술중출혈량소、조직손상경등우점。
Objective To compare the clinical outcomes of unilateral and bilateral pedicle screw fixation of minimally invasive transforaminal lumbar interbody fusion ( MIS-TLIF) for the treatment of lumbar disc herniation. Methods 46 patients with lumbar disc herniation were divided into two groups randomly, 18 cases of which were received oper-ation of unilateral pedicle screw fixation combined with single cage implantation of MIS-TLIF and other 28 cases were received operation of traditional bilateral fixation. Clinical outcomes were determined by using VAS score and ODI score criterion. Results The operation time in unilateral group was 90~160(115 ± 14. 5) min, bilateral group was 130~220(160 ± 17. 2) min. Difference between the two groups was statistically significant (P<0. 05). The blood loss in unilateral group was 210~450(300 ±41.8)ml, bilateral group was 300~600(420 ±56.3)ml. Difference was statistically significance between the two groups(P<0. 05). All patients were followed up for 15~31(25. 2 ± 5. 1)months in unilateral group, while 16~34(26. 4 ± 5. 6)months in bilateral group. The VAS score of the unilater-al group was 6. 0 ± 1. 2 before operation, and 2. 1 ± 1. 1 after operation,1-year follow-up was 2. 0 ± 1. 2. The bilateral group VAS score was 5. 9 ± 1. 6 before operation and 2. 0 ± 0. 8 after the surgery, 1-year follow-up was 12. 1 ± 0. 7. The ODI score of unilateral group was 43. 0 ± 1. 9 before operation, and 15. 0 ± 2. 8 after operation,1-year follow-up was 14. 0 ± 1. 9. The bilateral group ODI score was 42. 0 ± 2. 1 before surgery and 13. 0 ± 1. 9 after operation, 1-year follow-up was 12. 0 ± 1. 8. There were significant difference for the VAS score and ODI score postoperation compared with preoperation in each groups (P<0. 05), there was no statistically significant difference between the two groups (P>0. 05). There were no complications related to internal fixation breakage, loosening or cage displacement. Con-clusions Operation of unilateral pedicle screw fixation combined with single cage implantation of MIS-TLIF for the treatment of lumbar disc herniation has similar clinical outcome compared with traditional bilateral fixation way, which can minimize blood loss and tissue trauma, shorten the operative time.