(3.215.180.226) 您好!臺灣時間:2021/03/06 13:43
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
: 
twitterline
研究生:蔡惠庄
研究生(外文):Hui-Chuang Tsai
論文名稱:腰椎狹窄傳統與微創手術的醫療耗用與醫療品質差異分析
論文名稱(外文):The Differences of Medical Resource Utilization and Quality of Care between Traditional Surgery and Minimally Invasive Surgery among Patients with Spinal Stenosis
指導教授:應純哲應純哲引用關係盧康
指導教授(外文):Chun-Jhe YingKang Lu
學位類別:碩士
校院名稱:義守大學
系所名稱:醫務管理學系
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:59
中文關鍵詞:脊椎手術醫療耗用醫療品質
外文關鍵詞:spinal surgerymedical resources utilizationquality of care
相關次數:
  • 被引用被引用:2
  • 點閱點閱:169
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
由於全球人口老化趨勢日益嚴重,各國逐漸走向「超高齡社會」。因此,隨著年紀增長,退化性疾病「腰管狹窄」是一種慢性退化性關節疾病,因脊椎退化而骨刺漸漸形成,直接壓迫到椎管內的神經造成行動不便,引起老人家下背痛最常發生的原因。而現今社會的醫療科技及技術日益發達,雖傳統手術雖然能解決許多的問題,但也逐漸微創手術所取代。本研究目的想了解脊椎傳統手術和微創手術在手術過程中,比較醫療品質及醫療資源耗用差異分析,作為醫療政策上的規劃與運用之參考。
本研究之方法是以回溯性的方式收集資料,研究期間為2016年1月~2016年12月。研究對象為南部某區域教學醫院外科部腦神經外科就診而經確認有腰椎狹窄疾病(ICD-9 診斷碼:724.2),分別為接受傳統手術46位與微創手術44位共90位個案。並且運用敘述性統計(百分比、標準差、頻率),推論性統計(卡方檢定、獨立樣本t檢定)來分析資料,以 SPSS for Windows 19.0 套裝軟體進行統計分析。
本研究使用麻醉總時數、手術總時數與住院總日數做為代表性指標。由疾病嚴重度與醫療資源耗用的整理結果,可以知道腰椎狹窄的疾病嚴重度會影響醫療資源耗用。腰椎狹窄疾病牽涉的脊椎節數愈多,其病患的麻醉總時數、手術總時數與住院總日數就愈長。植入的人工植入物數量愈多,病患的手術總時數與住院總日數也愈長。接受不同處置之個案的各項醫療醫療資源耗用差異,接受傳統手術或微創手術患者之平均麻醉總時數及平均手術總時數皆無達到統計上顯著性得差異,但接受微創手術患者之住院總日數顯著少於接受傳統手術之患者。
對於腰椎狹窄以神經外科介入性處置是非常安全的治療方式。在個案醫院裡,接受傳統減壓手術或微創手術的病患,其住院期間皆無發生不良事件,但醫療資源耗用的情況有顯著差異,即接受傳統減壓手術的病患耗用較高的醫療資源。對於醫療機構、未來學術醫療工作者提供臨床上相關建議,以減少醫療資源的浪費及提升一般民眾就醫品質。
OBJECTIVE. Part of aging process, lumbar spinal stenosis (LSS) is the most common reason for degenerative changes with the lumbar column in elderly population. Lumbar spondylosis might result in mechanical back pain of various degrees, claudicant symptoms, reduced mobility and poor quality of life. Operative intervention is considered when the severely pain is not relieved by non-operative treatment. Open surgery (OS) is the surgical approach conventionally used for lumbar stenosis. However, greater change in multifidus, greater muscle damage and functional disability in terms of post-operative complications are frequently seen. In recent years, minimally invasive (MIS) treatment for decompression has become widely practiced for achieving effective operation and reducing approach related complications. It is predictable that medical resource utilization would be impacted with the aging population. The purposes of this research were: 1) to describe the distribution of selective LSS patients receiving operative intervention of different surgical approaches (MIS vs. OS) at our institution,2) to explore the quality of care of the above-mentioned patients,and 3) to analyze the medical resource utilization of the above-mentioned patients’。
METHODS. This is a retrospective chart review within a regional teaching hospital of patients underwent operative interventions (MIS vs. OS) for LSS (ICD-9 diagnosis code: 724.2) from January to December 2016.Complications after surgery as well as immediate re-operation for any reason were defined as indicators to quality of care, in addition, anesthesia duration, operation duration, and hospital length of stay were noted to define the medical resource utilization. All these parameters were used to evaluate the differences Between MIS and OS groups. Ninety patients (44 in the MIS group and 46 in the OS group) were further reviewed to better characterize the sample.
RESULTS. No patient developed any post-operative complication.No significant between group differences in terms of the average anesthesia duration and average operation duration were found. However, average length of hospital stay for the patients receiving OS was significantly higher than those who receiving MIS.
CONCLUSION. Neurosurgical intervention is safe for patients with LSS.Postoperative complication rates associated with these procedures are very low in the early postoperative period. The results warrant a further study with much bigger scale to evaluate the minimally invasive procedures which might reduce the hospital stay related resource utilization.
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機與目的 3
第二章 文獻探討 4
第一節 說明腰椎狹窄的發生、診斷與治療方式 4
第二節 接受不同腰椎狹窄手術病患之醫療結果實證研究 7
第三節 接受不同腰椎狹窄手術病患之醫療耗用實證研究 12
第四節 影響腰椎狹窄病患醫療資源耗用的關鍵影響因子 15
第三章 研究方法 17
第一節 研究對象與資料來源 17
第二節 研究變項與操作型定義 19
第三節 資料處理與統計分析方法 22
第四章 研究結果 23
第一節 基本資料結果 23
第二節 病患接受腰椎狹窄手術處置之醫療品質 27
第三節 病患接受腰椎狹窄手術處置之醫療耗用 28
第五章 討論 30
第一節 研究樣本之基本特質 30
第二節 討論 31
第三節 結論 33
第四節 建議 34
第五節 研究限制 35
參考文獻 37
附錄A 病歷摘錄表 49
附錄B 臨床試驗同意書 50
徐新怡(2010)。不同棘突間植入物在脊椎活動度與椎間盤壓力之生物力學研究。台北科技大學。
陳建民、陳瑩潔(2012)。微創脊椎手術輕鬆解決脊椎疾病。彰化基督教院訊。29(7),10-11。
胡名孝、楊曙華(2014)。脊椎微創手術。台灣醫學。18(5),529-535。
行政院衛生福利部:民國104年度國民醫療健保支出。取自:http://dep.mohw.gov.tw/DOS/lp-2156-113.html。引用2017/02/24。
行政院衛生福利部:民國104年度全民健康保險醫療統計年報。取自:http://dep.mohw.gov.tw/DOS/cp-2830-10153-113.html。引用2017/05/04。
Aebi, M. (2005). The adult scoliosis. Eur Spine J, 14(10), 925-948. doi:10.1007/s00586-005-1053-9
Ahn, Y., Lee, S. H., Lee, J. H., Kim, J. U., & Liu, W. C. (2009). Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien), 151(3), 199-206. doi: 10.1007/s00701-009-0204-x
Amundsen, T., Weber, H., Nordal, H. J., Magnaes, B., Abdelnoor, M., & Lilleas, F. (2000). Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976), 25(11), 1424-1435; discussion 1435-1426.
Arts, M. P., Brand, R., van den Akker, M. E., Koes, B. W., Bartels, R. H., Peul, W. C., & Leiden-The Hague Spine Intervention Prognostic Study, Group. (2009). Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial. JAMA, 302(2), 149-158. doi: 10.1001/jama.2009.972
Ba F(1991):Pain management in elderly people.J Am Geriatr Soc 39:64-73.
Benz, R. J., Ibrahim, Z. G., Afshar, P., & Garfin, S. R. (2001). Predicting complications in elderly patients undergoing lumbar decompression. Clin Orthop Relat Res(384), 116-121.
Birkenmaier, C., Suess, O., Pfeiffer, M., Burger, R., Schmieder, K., & Wegener, B. (2010). The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF). BMC Musculoskelet Disord, 11, 199. doi: 10.1186/1471-2474-11-199
Boakye, M., Patil, C. G., Ho, C., & Lad, S. P. (2008). Cervical corpectomy: complications and outcomes. Neurosurgery, 63(4 Suppl 2), 295-301; discussion 301-292. doi: 10.1227/01.NEU.0000327028.45886.2 E00006123-200810002-00012 [pii]
Burgstaller, J. M., Porchet, F., Steurer, J., & Wertli, M. M. (2015). Arguments for the choice of surgical treatments in patients with lumbar spinal stenosis - a systematic appraisal of randomized controlled trials. BMC Musculoskelet Disord, 16, 96. doi: 10.1186/s12891-015-0548-8
Caputy, A. J., & Luessenhop, A. J. (1992). Long-term evaluation of decompressive surgery for degenerative lumbar stenosis. J Neurosurg, 77(5), 669-676. doi: 10.3171/jns.1992.77.5.0669
Carragee, E. J. (1997). Single-level posterolateral arthrodesis, with or without posterior decompression, for the treatment of isthmic spondylolisthesis in adults. A prospective, randomized study. J Bone Joint Surg Am, 79(8), 1175-1180.
Carragee, E. J., Deyo, R. A., Kovacs, F. M., Peul, W. C., Lurie, J. D., Urrutia, G., . . . Schoene, M. L. (2009). Clinical research: is the spine field a mine field? Spine (Phila Pa 1976), 34(5), 423-430. doi: 10.1097/BRS.0b013e318198c962
Chen, C. L., Liu, C. L., Sun, S. S., Han, P. Y., Lee, C. S., & Lo, W. H. (2006). Posterolateral lumbar spinal fusion with autogenous bone chips from laminectomy extended with OsteoSet. J Chin Med Assoc, 69(12), 581-584.
Chiu, Y. C., Yang, S. C., Chen, H. S., Kao, Y. H., & Tu, Y. K. (2015). Posterior transpedicular approach with circumferential debridement and anterior reconstruction as a salvage procedure for symptomatic failed vertebroplasty. J Orthop Surg Res, 10, 28. doi: 10.1186/s13018-015-0169-9
Chou, D., Lau, D., Hermsmeyer, J., & Norvell, D. (2011). Efficacy of interspinous device versus surgical decompression in the treatment of lumbar spinal stenosis: a modified network analysis. Evid Based Spine Care J, 2(1), 45-56. doi: 10.1055/s-0030-1267086
Ciol, M. A., Deyo, R. A., Howell, E., & Kreif, S. (1996). An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc, 44(3), 285-290.
Cook, J. A., McCulloch, P., Blazeby, J. M., Beard, D. J., Marinac-Dabic, D., Sedrakyan, A., & Group, Ideal. (2013). IDEAL framework for surgical innovation 3: randomised controlled trials in the assessment stage and evaluations in the long term study stage. BMJ, 346, f2820. doi: 10.1136/bmj.f2820
Dagistan, Y., Dagistan, E., Gezici, A. R., Cancan, S. E., Bilgi, M., & Cakir, U. (2015). Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis. Clin Neurol Neurosurg, 139, 86-90. doi: 10.1016/j.clineuro.2015.09.009
Davis, R. J., Errico, T. J., Bae, H., & Auerbach, J. D. (2013). Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis: two-year results from the prospective, randomized, multicenter, Food and Drug Administration Investigational Device Exemption trial.Spine (Phila Pa 1976), 38(18), 1529-1539. doi: 10.1097/BRS.0b013e31829a6d0a
Deyo, R. A., Mirza, S. K., Martin, B. I., Kreuter, W., Goodman, D. C., & Jarvik, J. G. (2010). Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA, 303(13), 1259-1265. doi: 10.1001/jama.2010.338
Dohzono, S., Toyoda, H., Matsumura, A., Terai, H., Suzuki, A., & Nakamura, H. (2017). Clinical and Radiological Outcomes after Microscopic Bilateral Decompression via a Unilateral Approach for Degenerative Lumbar Disease: Minimum 5-Year Follow-Up. Asian Spine J, 11(2), 285-293. doi: 10.4184/asj.2017.11.2.285
Dorward, I. G., Lenke, L. G., Bridwell, K. H., O''Leary, P. T., Stoker, G. E., Pahys, J. M., Koester, L. A. (2013). Transforaminal versus anterior lumbar interbody fusion in long deformity constructs: a matched cohort analysis. Spine (Phila Pa 1976), 38(12), E755-762. doi: 10.1097/BRS.0b013e31828d6ca3
Fan, S., Hu, Z., Zhao, F., Zhao, X., Huang, Y., & Fang, X. (2010). Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J, 19(2), 316-324. doi: 10.1007/s00586-009-1191-6
Faundez, A. A., Mehbod, A. A., Wu, C., Wu, W., Ploumis, A., & Transfeldt, E. E. (2008). Position of interbody spacer in transforaminal lumbar interbody fusion: effect on 3-dimensional stability and sagittal lumbar contour. J Spinal Disord Tech, 21(3), 175-180. doi: 10.1097/BSD.0b013e318074bb7d
Fessler, R. G. (2003). Minimally invasive percutaneous posterior lumbar interbody fusion. Neurosurgery, 52(6), 1512.
Forsth, P., Michaelsson, K., & Sanden, B. (2013). Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: A two-year follow-up study involving 5390 patients. Bone Joint J, 95-B(7), 960-965. doi: 10.1302/0301-620X.95B7.30776
Forsth, P., Olafsson, G., Carlsson, T., Frost, A., Borgstrom, F., Fritzell, P., . . . Sanden, B. (2016). A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med, 374(15), 1413-1423. doi: 10.1056/NEJMoa1513721
Fritzell, P., Hagg, O., Nordwall, A., & Swedish Lumbar Spine Study, Group. (2003). Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J, 12(2), 178-189. doi: 10.1007/s00586-002-0493-8
Greenberg, M.S (1997). Spinal stenosis Handbook of Neurosurgery (Vol. 1, pp. 207-217). Lakeland, Fla: Greenburg Graphics, Inc.
Hanley, J. A., & Lippman-Hand, A. (1983). If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA, 249(13), 1743-1745.
Harkey, H. L., al-Mefty, O., Marawi, I., Peeler, D. F., Haines, D. E., & Alexander, L. F. (1995). Experimental chronic compressive cervical myelopathy: effects of decompression. J Neurosurg, 83(2), 336-341. doi: 10.3171/jns.1995.83.2.0336
He, E. X., Guo, J., Ling, Q. J., Yin, Z. X., Wang, Y., & Li, M. (2017). Application of a narrow-surface cage in full endoscopic minimally invasive transforaminal lumbar interbody fusion. Int J Surg, 42, 83-89. doi: 10.1016/j.ijsu.2017.04.053
Ho, Y. H., Tu, Y. K., Hsiao, C. K., & Chang, C. H. (2015). Outcomes after minimally invasive lumbar decompression: a biomechanical comparison of unilateral and bilateral laminotomies. BMC Musculoskelet Disord, 16, 208. doi: 10.1186/s12891-015-0659-2
Hsiang, J.K., & Furman, M.B. (2016, June 13, 2016). Spinal Stenosis. Retrieved October 31, 2016, 2016, from http://emedicine.medscape.com/article/1913265-overview
Jarrett, M. S., Orlando, J. F., & Grimmer-Somers, K. (2012). The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review. BMC Musculoskelet Disord, 13, 30. doi: 10.1186/1471-2474-13-30
Javid, M. J., & Hadar, E. J. (1998). Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study. J Neurosurg, 89(1), 1-7. doi: 10.3171/jns.1998.89.1.0001
Joseph, J. R., Smith, B. W., La Marca, F., & Park, P. (2015). Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus, 39(4), E4. doi: 10.3171/2015.7.FOCUS15278
Jutte, P. C., & Castelein, R. M. (2002). Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J, 11(6), 594-598. doi: 10.1007/s00586-002-0469-8
Kalichman, L., Cole, R., Kim, D. H., Li, L., Suri, P., Guermazi, A., & Hunter, D. J. (2009). Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J, 9(7), 545-550. doi: 10.1016/j.spinee.2009.03.005
Kim, J. S., Lee, K. Y., Lee, S. H., & Lee, H. Y. (2010). Which lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic spondylolisthesis? J Neurosurg Spine, 12(2), 171-177. doi: 10.3171/2009.9.SPINE09272
Kovacs, F. M., Urrutia, G., & Alarcon, J. D. (2011). Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976), 36(20), E1335-1351. doi: 10.1097/BRS.0b013e31820c97b1
Kreiner, D. S., Shaffer, W. O., Baisden, J. L., Gilbert, T. J., Summers, J. T., Toton, J. F., . . . North American Spine, Society. (2013). An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J, 13(7), 734-743. doi: 10.1016/j.spinee.2012.11.059
Lieberman, I. H., Togawa, D., Kayanja, M. M., Reinhardt, M. K., Friedlander, A., Knoller, N., & Benzel, E. C. (2006). Bone-mounted miniature robotic guidance for pedicle screw and translaminar facet screw placement: Part I--Technical development and a test case result. Neurosurgery, 59(3), 641-650; discussion 641-650. doi: 10.1227/01.NEU.0000229055.00829.5B
Liu, X., Yuan, S., & Tian, Y. (2013). Modified unilateral laminotomy for bilateral decompression for lumbar spinal stenosis: technical note. Spine (Phila Pa 1976), 38(12), E732-737. doi: 10.1097/BRS.0b013e31828fc84c
Machado, G. C., Ferreira, P. H., Harris, I. A., Pinheiro, M. B., Koes, B. W., van Tulder, M., . . . Ferreira, M. L. (2015). Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One, 10(3), e0122800. doi: 10.1371/journal.pone.0122800
Machado, G. C., Ferreira, P. H., Yoo, R. I., Harris, I. A., Pinheiro, M. B., Koes, B. W., Ferreira, M. L. (2016). Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev, 11, CD012421. doi: 10.1002/14651858.CD012421
Machado, G. C., Maher, C. G., Ferreira, P. H., Harris, I. A., Deyo, R. A., McKay, D., Ferreira, M. L. (2017). Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis. Spine (Phila Pa 1976). doi: 10.1097/BRS.0000000000002207
May, S., & Comer, C. (2013). Is surgery more effective than non-surgical treatment for spinal stenosis, and which non-surgical treatment is more effective? A systematic review. Physiotherapy, 99(1), 12-20. doi: 10.1016/j.physio.2011.12.004
Mobbs, R. J., Phan, K., Malham, G., Seex, K., & Rao, P. J. (2015). Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg, 1(1), 2-18. doi: 10.3978/j.issn.2414-469X.2015.10.05
Moojen, W. A., Arts, M. P., Bartels, R. H., Jacobs, W. C., & Peul, W. C. (2011). Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis. Eur Spine J, 20(10), 1596-1606. doi: 10.1007/s00586-011-1873-8
Moojen, W. A., Arts, M. P., Jacobs, W. C., van Zwet, E. W., van den Akker-van Marle, M. E., Koes, B. W., .Leiden-The Hague Spine Intervention Prognostic Study, Group. (2013). Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: randomized controlled trial. BMJ, 347, f6415. doi: 10.1136/bmj.f6415
Moojen, W. A., Bredenoord, A. L., Viergever, R. F., & Peul, W. C. (2014). Scientific evaluation of spinal implants: an ethical necessity. Spine (Phila Pa 1976), 39(26), 2115-2118. doi: 10.1097/BRS.0000000000000671
Moojen, W. A., & Van der Gaag, N. A. (2016). Minimally invasive surgery for lumbar spinal stenosis. Eur J Orthop Surg Traumatol, 26(7), 681-684. doi: 10.1007/s00590-016-1828-1
Nerland, U. S., Jakola, A. S., Solheim, O., Weber, C., Rao, V., Lonne, G., . . . Gulati, S. (2015). Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ, 350, h1603. doi: 10.1136/bmj.h1603
Parker, S. L., Anderson, L. H., Nelson, T., & Patel, V. V. (2015). Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer. Int J Spine Surg, 9, 28. doi: 10.14444/2028
Pechlivanis, I., Kiriyanthan, G., Engelhardt, M., Scholz, M., Lucke, S., Harders, A., & Schmieder, K. (2009). Percutaneous placement of pedicle screws in the lumbar spine using a bone mounted miniature robotic system: first experiences and accuracy of screw placement. Spine (Phila Pa 1976), 34(4), 392-398. doi: 10.1097/BRS.0b013e318191ed32
Phan, K., Rao, P. J., Ball, J. R., & Mobbs, R. J. (2016). Interspinous process spacers versus traditional decompression for lumbar spinal stenosis: systematic review and meta-analysis. J Spine Surg, 2(1), 31-40. doi: 10.21037/jss.2016.01.07
Ruetten, S., Komp, M., & Godolias, G. (2006). A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg, 49(2), 80-87. doi: 10.1055/s-2006-932172
Sansur, C. A., Reames, D. L., Smith, J. S., Hamilton, D. K., Berven, S. H., Broadstone, P. A., . . . Shaffrey, C. I. (2010). Morbidity and mortality in the surgical treatment of 10,242 adults with spondylolisthesis. J Neurosurg Spine, 13(5), 589-593. doi: 10.3171/2010.5.SPINE09529
Shamji, M. F., Goldstein, C. L., Wang, M., Uribe, J. S., & Fehlings, M. G. (2015). Minimally Invasive Spinal Surgery in the Elderly: Does It Make Sense? Neurosurgery, 77 Suppl 4, S108-115. doi: 10.1227/NEU.0000000000000941
Skidmore, G., Ackerman, S. J., Bergin, C., Ross, D., Butler, J., Suthar, M., & Rittenberg, J. (2011). Cost-effectiveness of the X-STOP(R) interspinous spacer for lumbar spinal stenosis. Spine (Phila Pa 1976), 36(5), E345-356. doi: 10.1097/BRS.0b013e3181f2ed2f
Stromqvist, B. H., Berg, S., Gerdhem, P., Johnsson, R., Moller, A., Sahlstrand, T., . . . Tullberg, T. (2013). X-stop versus decompressive surgery for lumbar neurogenic intermittent claudication: randomized controlled trial with 2-year follow-up. Spine (Phila Pa 1976), 38(17), 1436-1442. doi: 10.1097/BRS.0b013e31828ba413
Sukovich, W., Brink-Danan, S., & Hardenbrook, M. (2006). Miniature robotic guidance for pedicle screw placement in posterior spinal fusion: early clinical experience with the SpineAssist. Int J Med Robot, 2(2), 114-122. doi: 10.1002/rcs.86
Szpalski M GR: Lumbar spinal stenosis: clinical features and new trends in surgical treatment.Geriatric Times V, 2004.
Thome, C., Zevgaridis, D., Leheta, O., Bazner, H., Pockler-Schoniger, C., Wohrle, J., & Schmiedek, P. (2005). Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine, 3(2), 129-141. doi: 10.3171/spi.2005.3.2.0129
van den Akker-van Marle, M. E., Moojen, W. A., Arts, M. P., Vleggeert-Lankamp, C. L., Peul, W. C., & Leiden-The Hague Spine Intervention Prognostic Study, Group. (2016). Interspinous process devices versus standard conventional surgical decompression for lumbar spinal stenosis: cost-utility analysis. Spine J, 16(6), 702-710. doi: 10.1016/j.spinee.2014.10.017
Wang, H., Wang, T., Wang, Q., & Ding, W. (2017). Incidence and risk factors of persistent low back pain following posterior decompression and instrumented fusion for lumbar disk herniation. J Pain Res, 10, 1019-1025. doi: 10.2147/JPR.S132862
White, AA III, & Panjabi, MM. (1990) Clinical Biomechanics of the Spine (2nd ed. ed., pp. 342-378). Philadelphia, Pa: JB Lippincott.
Xin, Z., Liao, W., Ao, J., Qin, J., Chen, F., Ye, Z., & Cai, Y. (2017). A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations. Biomed Res Int, 2017, 3069575. doi: 10.1155/2017/3069575
Yang, Y., Liu, B., Rong, L. M., Chen, R. Q., Dong, J. W., Xie, P. G., . . . Feng, F. (2015). Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med, 8(11), 21319-21326.
Zucherman, J. F., Hsu, K. Y., Hartjen, C. A., Mehalic, T. F., Implicito, D. A., Martin, M. J., . . . Ozuna, R. M. (2005). A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine (Phila Pa 1976), 30(111), 1424-1435; discussion 1435-1426.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
系統版面圖檔 系統版面圖檔