요추협착증에 대한 양공접근내시경감압술과 감압동반유합술의 임상적 결과 및 의료비용에 대한 비교 분석

다국어 초록 (Multilingual Abstract)

Spinal stenosis is one of most common degenerative diseases in elderly patients over the age of 60. Various treatment options are not simply focused on decreasing of back pain but also on improving the quality of life for older patients. Wider decompression with fusion and posterior instrumentation had been thought once as the gold standard ;however, it has become apparent that this technique can lead to severe postoperative complications and patient disabilities. Wider decompressive spine surgery should be changed to minimally invasive surgery by using several facilities such as loupe, microscope, tubular retractor, endoscope or arthroscope. Minimally invasive decompression with fusion using a microscope and a tubular retractor was developed to decrease paravertebral muscle injury and blood loss. This can guarantee clear discrimination of structures for safer manipulation of neural structures, but narrower working space through a tubular retractor may not be helpful in preserving bony structures to keep the spinal stability. Therefore, minimally invasive fusion surgery became more prevalent. Percutaneous uniportal endoscopic spine surgery was developed for disc problem and it has been adapted to decompression without fusion by preserving spinal bony structures in these days. But indication of uniportal endoscopic spine surgery has very shallow and the clinical results of this technique could not overcome those of minimally invasive decompression with fusion due to its technical trait.
 Biportal endoscopic decompression uses two skin incision about 1cm in length to insert an arthroscope and a certain instrument for decompression surgery. With no muscle dissection and less bleeding, the spinal structures deeper inside can be accessed and decompressed while preserving spinal stability. Consequently, it can make it possible to perform decompression-only even for severe degenerative spinal stenosis. Complications associated with wider skin incision and excess distraction of muscles, wound infection and muscle atrophy with open dissection, adjacent segment disease and additional fusion surgery with rigid fusion and instrumentation can be escapable and preventable. The medical cost for additional revision surgery in early following-up due to severe postoperative complications also could be reduced according to the lower range of surgical intervention and less minor complications of biportal endoscopic decompression.
This study proceeded to reveal benefits of clinical and economic point of views in this brand-new technique, biportal endoscopic decompression, for degenerative lumbar spinal stenosis.

목차 (Table of Contents)

• I. 서론 1
• 1. 연구의 배경 및 필요성 1
• 2. 연구의 목적 6
• II. 이론적 고찰 8
• 1. 척추관 협착증의 개요 8
• 2. 요추협착증의 수술적 치료 8
• (1) 광범위 후방감압동반유합술 9
• (2) 최소칩습 후방감압동반유합술 11
• (3) 최소침습 후방감압술 12
• (4) 양공접근내시경감압술 15
• 3. 요추협착증 치료에 대한 문헌 고찰 20
• (1) 후방감압동반유합술후 임상적 만족도 및 삶의 질 평가 20
• (2) 비용 - 효과 분석 21
• III. 연구 방법 24
• 1. 분석 모형 설계 25
• (1) 연구 대상 집단 25
• (2)분석의 관점 28
• (3) 분석 요소 28
• (4) 편향 조정 29
• (5) 통계 분석 30
• IV. 결과 31
• 1. 연구 대상 집단의동질성 31
• 2. 임상결과 분석 33
• (1) 재원일수 33
• (2) 의료비용 33
• (3) 수혈 빈도 34
• (4) 퇴원후 의료기관 내원 빈도 34
• (5) 술후 창상 감염 빈도 35
• (6) 재수술 시행 빈도 35
• 3. 의료비용 분석 38
• (1) 보험 급여 비용분석 41
• (2) 보험 비급여 비용 분석 42
• (3) 재수술시 의료비용 분석 42
• (4) 총 의료비용 비교 43
• V. 고찰 44
• 1. 연구 방법에 대한 고찰 44
• 2. 연구 결과에 대한 고찰 46
• 3. 양공접근내시경감압술에 대한 고찰 49
• 4. 연구의 제한점 56
• VI. 결론 및 제안 58
• 참고문헌 60
• 별첨 66