CAJ | 학술논문

背景:胸腰椎爆裂型骨折的主要危害是原发和/或继发性损伤所造成的脊髓神经损伤,有报道经后路器械复位内固定对爆裂骨折的复位和对椎管的间接减压是有效的.目的:探讨经前路减压后应用史塞克胸腰椎前路钢板内固定系统治疗胸腰椎爆裂型骨折并截瘫患者,改善术后椎管狭窄及脊柱力线的效果.设计:病例报告.单位:一所市级医院骨科.对象:选择2001-09/2002-02东莞市太平人民医院骨科收治的胸腰椎爆裂型骨折并脊髓功能障碍患者5例,男4例,女1例;年龄17～34岁.方法:对5例患者进行前路彻底减压,取髂骨或/和肋骨行椎间植骨,应用史塞克胸腰椎前路钢板内固定系统进行复位、内固定.于术后1,3,5,9个月拍X射线片,观察植骨融合情况、椎管狭窄面积及后凸角改善效果;随访时采用Frankel分级评定脊髓功能(A级为差,E级为优).主要观察指标:①手术前后脊髓功能Frankel分级.②后凸成角情况及椎管狭窄面积.结果:5例患者均进入结果分析.随访时间8个月.①椎间植骨全部完全融合,融合时间平均4个月.②Frankel分级除1例患者达2级以上改善外,其余患者均获得行走功能,Frankel分级达E级.③椎管狭窄面积术前平均为68.9%,术后椎管无狭窄.④术前脊柱后凸成角15°～30°,术后为0°～6°,术后脊柱后凸角较术前明显改善.结论:经前路减压直接彻底,为脊髓神经功能的恢复提供了良好环境.史塞克胸腰椎前路钢板内固定系统治疗胸腰椎爆裂型骨折并截瘫患者可以有效地恢复脊柱生理弯曲,且操作简单,固定牢固,具有内固定材料的生物学特征.
배경:흉요추폭렬형골절적주요위해시원발화/혹계발성손상소조성적척수신경손상,유보도경후로기계복위내고정대폭렬골절적복위화대추관적간접감압시유효적.목적:탐토경전로감압후응용사새극흉요추전로강판내고정계통치료흉요추폭렬형골절병절탄환자,개선술후추관협착급척주력선적효과.설계:병례보고.단위:일소시급의원골과.대상:선택2001-09/2002-02동완시태평인민의원골과수치적흉요추폭렬형골절병척수공능장애환자5례,남4례,녀1례;년령17～34세.방법:대5례환자진행전로철저감압,취가골혹/화륵골행추간식골,응용사새극흉요추전로강판내고정계통진행복위、내고정.우술후1,3,5,9개월박X사선편,관찰식골융합정황、추관협착면적급후철각개선효과;수방시채용Frankel분급평정척수공능(A급위차,E급위우).주요관찰지표:①수술전후척수공능Frankel분급.②후철성각정황급추관협착면적.결과:5례환자균진입결과분석.수방시간8개월.①추간식골전부완전융합,융합시간평균4개월.②Frankel분급제1례환자체2급이상개선외,기여환자균획득행주공능,Frankel분급체E급.③추관협착면적술전평균위68.9%,술후추관무협착.④술전척주후철성각15°～30°,술후위0°～6°,술후척주후철각교술전명현개선.결론:경전로감압직접철저,위척수신경공능적회복제공료량호배경.사새극흉요추전로강판내고정계통치료흉요추폭렬형골절병절탄환자가이유효지회복척주생리만곡,차조작간단,고정뢰고,구유내고정재료적생물학특정.
BACKGROUND: The most dangerous consequence of thoracolumbar burst fracture is its neurological deficits(caused by primary and/or secondary injury) . It is reported that posterior spinal decompression combined with internal fixation are viable in reduction of fracture and indirect decompression of obstructed spinal canal.OBJECTIVE: To evaluate the effect of anterior decompression combined with STRYKER thoracoluambar anterior internal fixation system in improving spinal canal stenosis and spinal mechanical axis in thoracolumbar burst fracture.DESIGN:It is a case report.SETTING:An orthopedic department of a municipal hospital.PARTICIPANTS:In this study, five patients (four male, one female, aged 17 - 34 years) were recruited who suffered from thoracolumbar burst fracture and spinal cord dysfunction and were treated in the Orthopaedic Departnent of Dongguan Taiping People' s Hospital from September 2001 to February 2002.METHODS: All patients received anterior decompression and intervertebral grafting with iliac or rib bone flap combined with reduction and internal fixation by STRYKER system. X-rays of thoracolumbar vertebrae were taken in the 1st, 3rd, 5th and 9th post-operative months for observation of fusion of injured segments, improvement of narrowed spinal canal and kyphosis angle. And Frankel scale was adopted for evaluation of the patients during follow-up(A for bad and E for excellent).narrowed spinal canal.RESULTS: All of the 5 patients entered analytic stage and follow-up lasted grade B in one patient, all the others got Frankel grade E and could walk gical operation was 68.9% and after operation there was no spinal canal tion to 0° - 6° afterward.CONCLUSION: Anterior spinal decompression can directly and completely provide satisfactory environment for the recovery of neurological of deficits spinal cord. STRYKER thoracoluambar anterior internal fixation system applied in patients with thoracolumbar burst fracture and paraplegia can effectively restore normal spinal curve with the advantages of simple procedure and stable fixation as well as the characteristics of biological internal fixation such as satisfactory reduction and stable fixation.