성인의 요추전전위증에 대한 골융합술의 효과 ; 후측방융합술과 Cage를 이용한 후방 추체간 융합술의 비교
Outcome Comparison of Instrumented Posterolateral Fusion and Posterior Lumbar Interbody Fusion with Cages for Surgical Management of Lumbar Spondylolisthesis In Adults
소속 상세정보
문성호/Sung Ho Mun
이승민/양재영/최천식/주문배/어환/박윤관/서중근/Seung Min Lee/Jar Young Yang/Chun Sik Choi/Moon Bae Ju/Whan Eoh/Yun Kwan Park/Jung Keun Suh
KMID : 0359819980270111548
Abstract
결 론
요추전전위증이 있는 75명의 성인환자에게 두가지 방법 (PLF and TPSF과 PLIF with
cages and TPSF)의 골융합술을 시행하고 임상추적결과를 후향적으로 비교분석하였다. 골융
합율에서는 두 방법간에 유의한 차이를 보이지 않았다. 그러나 PLIF를 시행받은 환자군에서
디스크공간의 높이의 변화, 시상각의 변화 등 전전위증의 방사선학적 교정정도가 유의하게
큰 것으로 나타났고, Prolo scale로 측정한 술 후 임상상태도 유의하게 좋은 것으로 나타났
다. 그러나 수술시간, 출혈량, 합병증 등은 PLF를 시행받은 환자군에 비해 길거나 많았던
것으로 나타나 PLIF 수술시 세밀하고 숙련된 수기가 필요할 것으로 생각한다. 그리고 단계
적 다중선형회귀분석 결과 수술방법과 전전위증의 부위, 두 요소만이 술 후 임상결과에 유
의한 영향을 미치는 임상요소인 것으로 밝혀졌다.
#초록#
For the primary fusion of adult's lumbar spondylolisthesis the authors performed
either posterolateral fusion(PLE) with transpedicular screw fixation, or posterior lumbar
interbody fusion(PLIF) with cages and transpedicular screw fixation, on 75 patients
during five years between jan. 1993 and Dec. 1997. The outcomes were retrospectively
reviewed with emphasis on comparison of the results or these two surgical methods.
Between patients treated with PLF(FLF group) and FLIF(FLIF group) there were no
differences in distribution of preoperative variables such as patients' age and gender,
type, level, grade of spondylolisthesis, and symptom durations. Mean follow-up period
was 22.3 months in PLF group(n=44) and 17.4 months in PLIF group(n=31)(p<0.001).
The rate of fusion was 85% in PLF group, and 94% in PLIF group(p=0.292. The
postoperative outcome, expressed as mean follow-up score of Prolo scale, was 6.86 in
PLE group and 7.42 in PLIF group(p=0.007). the variables that were associated with the
outcomes were the level of spondylolisthesis(p=0.001) and the type of fusion(p=0.023).
Variables such as age gender. type and grades of spondylolisthesis. preoperative
symptom duration, radiological findings of fusion status, change in disc height, and
change in sagittal angle were not associated with the outcomes. The complication rate
was 11% in PLF group and 19% in PLIF group. Overall successful results, defined by 7
or more in follow-up score of Prolo scale, were seen in 68% of PLF group and 87% of
PLIF group(p=0.098).
It is concluded that better surgical outcomes were obtained by PLIF methods in adults
with lumbar spondylolisthesis, but with regards to the incidence of complications,
although mostly minor and reversible, was more frequent in PLIF group.
키워드
Spondylolisthesis; Posterolateral fusion; Posterior lumber interbody fusion; Fusion cage.;
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