CAJ | 학술논문

目的：分析经椎间孔椎间融合术（ TLIF）联合椎弓根螺钉固定在腰椎退行性疾病中的疗效及远期预后。方法选取2010年5月至2014年5月涿州市医院收治的96例腰椎退行性疾病患者为研究对象，按照随机数字表法分为观察组和对照组，各48例。观察组实施 TLIF 联合椎弓根螺钉固定术，对照组实施传统的经后路腰椎间融合手术。术后均给予抗生素静脉滴注治疗，并对患者进行为期5年的随访和X线平片复查，观察两组患者的疼痛、并发症、植骨融合情况，进行 Oswestry功能障碍指数（ODI）、疼痛视觉模拟评分（VAS），对两种手术的疗效进行对比分析。结果观察组患者的住院时间、术中失血量、切口长度、术后引流量均明显少于对照组[（9.9±1.1） d 比（12.2±0.9） d；（302±30） mL比（338±44） mL；（2.6±0.7） cm比（6.3±2.5） cm；（87±13） mL比（119±20） mL]，但观察组的手术时间长于对照组[（134±20） min比（109±26） min]，差异有统计学意义（P＜0.01）；按照改良MacNab标准的疗效评定结果显示，两组患者临床疗效比较差异无统计学意义（ P＞0.05）；两组患者的植骨融合率均较高，融合情况好，但两组比较差异无统计学意义（ P＞0.05）；两组患者的ODI评分、VAS较术前均明显改善，差异有统计学意义（ P＜0.05）；观察组总并发症发生率低于对照组[48.9％（22／45）比64.3％（27／42）]，差异有统计学意义（P＜0.05）。结论 TLIF联合椎弓根螺钉固定在腰椎退行性疾病中疗效显著，远期预后效果良好。较传统的手术方法具有创伤小、失血量少、并发症少的优点，是值得推广应用的治疗腰椎退行性疾病的安全有效的方法。
목적：분석경추간공추간융합술（ TLIF）연합추궁근라정고정재요추퇴행성질병중적료효급원기예후。방법선취2010년5월지2014년5월탁주시의원수치적96례요추퇴행성질병환자위연구대상，안조수궤수자표법분위관찰조화대조조，각48례。관찰조실시 TLIF 연합추궁근라정고정술，대조조실시전통적경후로요추간융합수술。술후균급여항생소정맥적주치료，병대환자진행위기5년적수방화X선평편복사，관찰량조환자적동통、병발증、식골융합정황，진행 Oswestry공능장애지수（ODI）、동통시각모의평분（VAS），대량충수술적료효진행대비분석。결과관찰조환자적주원시간、술중실혈량、절구장도、술후인류량균명현소우대조조[（9.9±1.1） d 비（12.2±0.9） d；（302±30） mL비（338±44） mL；（2.6±0.7） cm비（6.3±2.5） cm；（87±13） mL비（119±20） mL]，단관찰조적수술시간장우대조조[（134±20） min비（109±26） min]，차이유통계학의의（P＜0.01）；안조개량MacNab표준적료효평정결과현시，량조환자림상료효비교차이무통계학의의（ P＞0.05）；량조환자적식골융합솔균교고，융합정황호，단량조비교차이무통계학의의（ P＞0.05）；량조환자적ODI평분、VAS교술전균명현개선，차이유통계학의의（ P＜0.05）；관찰조총병발증발생솔저우대조조[48.9％（22／45）비64.3％（27／42）]，차이유통계학의의（P＜0.05）。결론 TLIF연합추궁근라정고정재요추퇴행성질병중료효현저，원기예후효과량호。교전통적수술방법구유창상소、실혈량소、병발증소적우점，시치득추엄응용적치료요추퇴행성질병적안전유효적방법。
Objective To analyze the efficacy and long-term prognosis of transforaminal lumbar inter-body fusion( TLIF) joint pedicle screw fixation in lumbar degenerative diseases .Methods A total of 96 patients with degenerative lumbar disease were chosen from Zhuozhou City Hospital from May 2010 to May 2014 in this study,according to random number table method they were divided into obervation group and control group,48 cases each.TLIF joint pedicle screw fixation was implemented for the observation group , while the traditional posterior lumbar fusion surgery was implemented for the control group .Postoperative anti-biotics were given by intravenous administration ,and 5-year follow-up and X-ray review to observe pain,com-plications,bone fusion,and conduct oswestry disability index ( ODI) ,pain visual analogue scale ( VAS) sco-ring to compare the efficacy of the two procedures.Results The hospitalization days,intraoperative blood loss,incision length,postoperative drainage were significantly less than the control group[(9.9 ±1.1) d vs (12.2 ±0.9) d;(302 ±30) mL vs (338 ±44) mL;(2.6 ±0.7) cm vs (6.3 ±2.5) cm;(87 ±13) mL vs (119 ±20) mL],but the surgery time of the observation group was longer[(134 ±20) min vs (109 ± 26) min],the difference was statistically significant(P<0.01);there was no significant difference in the clinical efficacy according to the modified MacNab criteria ( P<0.05 );both groups had high fusion rate with good fusion status,the difference between groups was not statistically significant(P>0.05).After 5 years of observation,ODI,VAS scores of both groups were significantly improved compared than before operation with significant differences(P<0.05); and complication rate in the observation group was lower than the control group[48.9%(22/45) vs 64.3%(27/42)](P<0.05).Conclusion TLIF combined with pedicle screw fixation has significant effect for the treatment of the lumbar degenerative diseaseswith good long-term progno-sis.Compared with traditional surgical methods it is featured with less trauma ,less blood loss and less compli-cation.It′s a safe and effective method for the treatment of lumbar degenerative disease and worthy of applica-tions.