CAJ | 학술논문

目的比较经Wiltse入路微创椎间非融合K-Rod内固定术与传统后正中入路椎间非融合K-Rod内固定术对单节段腰椎间盘突出症(LDH)的短期疗效.方法椎间盘髓核摘除+K-Rod后路固定治疗单节段腰椎间盘突出症59例.按手术方式分为两组:经Wiltse入路微创组26例;传统经后正中入路开放组33例.观察对比两组患者手术时间、术中出血量、术后引流量、平均住院时间.按日本骨科协会(JOA)评分、背部及下肢视觉模拟评分法(VAS)比较两组短期治疗效果.结果开放组JOA评分术前为(10.70 ±3.40)分,术后为(27.45±1.00)分,下肢VAS评分术前为(7.79±0.63)分,术后为(1.28±0.32)分,背部VAS评分术前为(7.80±0.63)分,术后为(1.48±0.47)分;Wiltse组JOA评分术前为(11.77 ±4.36)分,术后为(27.92 ±0.97)分,下肢VAS评分术前为(7.66±0.68)分,术后为(1.19±0.25)分,背部VAS评分术前为(7.75±0.68)分,术后为(1.07±0.29)分,术前术后评分差异有统计学意义(P＜0.05).关于JOA改善率、手术时间、术中出血量、术后引流量、平均住院日,开放组分别为(91.88±4.61)％、(98.09 ±8.52) min、(241.09 ±65.33) ml、(230.15 ±65.96) ml、(12.88 ±1.38)d,Wiltse组分别为(94.08±4.78)％、(97.54±7.19) min、(103.27 ±33.16) ml、(0.00±0.00)ml、(7.08±1.46)d,两组间比较JOA改善率、手术时间差异无统计学意义(P＞0.05),Wiltse组背部术后VAS评分、术中出血量、术后引流量、平均住院日均低于于开放组,差异有统计学意义(P＜0.05).结论与传统后正中开放入路比较,经Wiltse入路K-Rod内固定对治疗单节段椎间盘突出的近期效果更为满意,其在控制出血及缓解腰背部疼痛症状均优于传统后正中入路K-Rod固定.
목적 비교경Wiltse입로미창추간비융합K-Rod내고정술여전통후정중입로추간비융합K-Rod내고정술대단절단요추간반돌출증(LDH)적단기료효.방법 추간반수핵적제+K-Rod후로고정치료단절단요추간반돌출증59례.안수술방식분위량조:경Wiltse입로미창조26례;전통경후정중입로개방조33례.관찰대비량조환자수술시간、술중출혈량、술후인류량、평균주원시간.안일본골과협회(JOA)평분、배부급하지시각모의평분법(VAS)비교량조단기치료효과.결과 개방조JOA평분술전위(10.70 ±3.40)분,술후위(27.45±1.00)분,하지VAS평분술전위(7.79±0.63)분,술후위(1.28±0.32)분,배부VAS평분술전위(7.80±0.63)분,술후위(1.48±0.47)분;Wiltse조JOA평분술전위(11.77 ±4.36)분,술후위(27.92 ±0.97)분,하지VAS평분술전위(7.66±0.68)분,술후위(1.19±0.25)분,배부VAS평분술전위(7.75±0.68)분,술후위(1.07±0.29)분,술전술후평분차이유통계학의의(P＜0.05).관우JOA개선솔、수술시간、술중출혈량、술후인류량、평균주원일,개방조분별위(91.88±4.61)％、(98.09 ±8.52) min、(241.09 ±65.33) ml、(230.15 ±65.96) ml、(12.88 ±1.38)d,Wiltse조분별위(94.08±4.78)％、(97.54±7.19) min、(103.27 ±33.16) ml、(0.00±0.00)ml、(7.08±1.46)d,량조간비교JOA개선솔、수술시간차이무통계학의의(P＞0.05),Wiltse조배부술후VAS평분、술중출혈량、술후인류량、평균주원일균저우우개방조,차이유통계학의의(P＜0.05).결론 여전통후정중개방입로비교,경Wiltse입로K-Rod내고정대치료단절단추간반돌출적근기효과경위만의,기재공제출혈급완해요배부동통증상균우우전통후정중입로K-Rod고정.
Objective To compare the short-term clinical effects between the minimally invasive discetomy with non-fusion K-Rod fixation system by Wiltse approach via a tube and the discetomy with non-fusion K-Rod fixation system by traditional posterior midline approach in the treatment of single segmental lumbar disc herniation (LDH).Methods A retrospective analysis of 59 patients who were treated by discectomy plus K-Rod fixation system was carried out.According to the surgery approach, these patients were divided into two different groups: 26 cases in the Wiltse group and the open approach group had 33 cases.By comparing the surgical time, blood loss, postoperative drainage, and average length of hospital stay, the approach-related effects were evaluated.And statistical comparison of preoperative and final follow-up results of the Japanese Orthopaedic Association (JOA) score, and lower back and lower extremity visual analogue scale (VAS) scores could indicate the short-term clinical outcome.Results In open approach group, the JOA score was 10.70 ± 3.40 and 27.45 ± 1.00 pre-and postoperation respectively, and the lower limb and back VAS score was 7.79 ± 0.63 and 7.80 ± 0.63 pre-operation and 1.28 ± 0.32 and 1.48 ± 0.47 post-operation respectively.In Wiltse group, the JOA score was 11.77 ± 4.36 and 27.92 ± 0.97 pre-and postoperation respectively, and the lower limb and back VAS score was 7.66 ±0.68 and 7.75 ±0.68 pre-operation and 1.19 ± 0.25 and 1.07 ± 0.29 post-operation respectively.There was statistically significant difference in the above indexes pre-operation and post-operation (P ＜ 0.05).The JOA improvement rate, operative time, blood loss, postoperative drainage, and average length of hospital stay in open approach group were (91.88 ±4.61)％, (98.09 ±8.52) min, (241.09 ± 65.33) ml, (230.15 ±65.96) ml, and (12.88 ± 1.38) days, and those in Wiltse group were (94.08 ± 4.78) ％, (97.54 ± 7.19) min, (103.27 ± 33.16) ml, (0.00 ± 0.00) ml, and (7.08 ± 1.46) days, respectively.There was no statistically significant difference between the two groups in JOA improvement rate and operative time (P ＞ 0.05).The back VAS score, blood loss, postoperative drainage, and average length of hospital stay in Wiltse Group were significantly reduced as compared with those in open approach group (P ＜ 0.05).Conclusion Compared with the traditional posterior midline approach, the K-Rod internal fixation by Wiltse minimally invasive approach via a tube for the treatment of single segment LDH gained a more satisfied short-term effect, especially in its performance in the bleeding control and amelioration of lower back pain.