CAJ | 학술논문

目的探讨采用新型椎体扩张器经椎弓根椎体内自体骨植骨结合椎弓根内固定治疗胸腰段爆裂性骨折的近期疗效.方法 2007年8月至2008年3月共收治胸腰段爆裂性骨折16例,根据AO分型:A2型10例.A3型6例.按ASIA脊髓神经功能障碍分级标准:A级2例,B级2例,C级2例,D级3例,E级7例.采用自行设计的新型椎体扩张器经伤椎椎弓根椎体内自体骨植骨,椎管减压(或不减压),相邻节段椎弓根内固定. 结果伤椎椎体前缘高度由术前(18.3±2.5)mm恢复到术后(25.1±2.8)mm,Cobb角由术前36.33°±2.14°恢复到术后2.77°±0.41°(术后1周),差异均有统计学意义(P<0.01).伤椎经扩张器扩张后平均椎体内植骨量(10.53±3.62)cm3 椎体扩张器下伤椎椎体内植骨未引起神经、血管损伤等术中和术后并发症,术后随访6个月,椎体内植骨融合良好,伤椎前缘高度丢失和Cobb角与术后1周相比无明显变化,不完全性神经损伤术后脊髓神经功能有1～2级的恢复. 结论采用新型椎体扩张器经伤椎椎弓根椎体内自体骨植骨治疗胸腰段爆裂性骨折可有效恢复伤椎椎体高度,重建前中柱的稳定性,防止术后由于椎体高度丢失所导致的并发症;椎体扩张器具有良好的临床运用价值.
목적 탐토채용신형추체확장기경추궁근추체내자체골식골결합추궁근내고정치료흉요단폭렬성골절적근기료효.방법 2007년8월지2008년3월공수치흉요단폭렬성골절16례,근거AO분형:A2형10례.A3형6례.안ASIA척수신경공능장애분급표준:A급2례,B급2례,C급2례,D급3례,E급7례.채용자행설계적신형추체확장기경상추추궁근추체내자체골식골,추관감압(혹불감압),상린절단추궁근내고정. 결과 상추추체전연고도유술전(18.3±2.5)mm회복도술후(25.1±2.8)mm,Cobb각유술전36.33°±2.14°회복도술후2.77°±0.41°(술후1주),차이균유통계학의의(P<0.01).상추경확장기확장후평균추체내식골량(10.53±3.62)cm3 추체확장기하상추추체내식골미인기신경、혈관손상등술중화술후병발증,술후수방6개월,추체내식골융합량호,상추전연고도주실화Cobb각여술후1주상비무명현변화,불완전성신경손상술후척수신경공능유1～2급적회복. 결론 채용신형추체확장기경상추추궁근추체내자체골식골치료흉요단폭렬성골절가유효회복상추추체고도,중건전중주적은정성,방지술후유우추체고도주실소도치적병발증;추체확장기구유량호적림상운용개치.
Objective To investigate the effect of the self-designed dilator-kyphoplasty combined with autologous bone graft in fractured vertebra for treatment of thoracolumbar burst fractures. Methods From August 2007 to March 2008, 16 patients with thoracolumbar burst fracture were treated by our self-designed dilator-kyphoplasty combined with autologous bone graft in fractured vertebra. Based on AO classification, 10 patients were of A2 and 6 of A3. According to the ASIA (American Spinal Injury Associ-ation) neurological function grading system, there were 2 cases of grade A, 2 grade B, 2 grade C, 3 grade D and 7 grade E. Results On average, the anterior height of fractured vertebrae increased from 18.3±2.5 mm before operation to (25.1±2.8) mm after operation. Their mean Cobb' s angle was restored from 36.33°±2.14°before operation to 2.77°±0.41°after operation. The average amount of bone graft was (10.53±3.62) cm3. There was no perioperative or postoperative vessel or nerve injury. A follow-up of 6 months re-vealed fine fusion of grafts and no implant rupture or loosening. For patients with incomplete neurological injuries, improvement of 1 to 2 grades was made in neurological functions. Conclusion Because the self-designed dilator-kyphoplasty may effectively restore the height of fractured vertebrae, reconstruct the sta-bility of anterior and middle columns of the fractured vertebrae and avoid the complications caused by simple pedicle screw fixation, it should be used widely in clinic for thoracolumbar burst fractures.