CAJ | 학술논문

目的探讨后路小切口单节段侧前方减压前柱重建术治疗Denis B犁胸腰椎爆裂骨折的可行性及临床疗效.方法回顾性分析2007年8月-2009年8月采用经后路小切口椎弓根钉内同定、单间隙侧前方减压、钛网植骨融合重建前柱治疗Denis B型胸腰椎爆裂性骨折21例,其中男15例,女6例;年龄23～50岁,平均35.6岁.骨折累及节段:T126例,L111例,L2 3例,L31例.术前椎管占位率平均62.5%,所有患者椎体前中柱压缩均≤50%,CT平扫示椎体下份及下终板骨结构正常.通过术前、术后即刻及末次随访时X线、CT片及神经学检查,观察骨折复位、植骨融合、神经功能恢复、矫正丢失、腰椎活动情况及相邻椎间盘退变等情况.结果本组患者手术时间1.5～3.2 h,平均2.1 h.出血量350～1 000 ml,平均580 ml.21例患者术后均获4～26个月(平均10.3个月)随访.椎体问融合时间约4～6个月,随访中椎体高度无丢失.无断钉、断棒或内置物松动、移位等并发症,神经功能均有1～2级改善.结论只要适应证选择合适,后路小切口单节段侧前方减压前柱重建术具有操作安全简便、手术创伤小、融合节段少、术后康复快的优点,是一种安全有效的手术方式.
목적 탐토후로소절구단절단측전방감압전주중건술치료Denis B리흉요추폭렬골절적가행성급림상료효.방법 회고성분석2007년8월-2009년8월채용경후로소절구추궁근정내동정、단간극측전방감압、태망식골융합중건전주치료Denis B형흉요추폭렬성골절21례,기중남15례,녀6례;년령23～50세,평균35.6세.골절루급절단:T126례,L111례,L2 3례,L31례.술전추관점위솔평균62.5%,소유환자추체전중주압축균≤50%,CT평소시추체하빈급하종판골결구정상.통과술전、술후즉각급말차수방시X선、CT편급신경학검사,관찰골절복위、식골융합、신경공능회복、교정주실、요추활동정황급상린추간반퇴변등정황.결과 본조환자수술시간1.5～3.2 h,평균2.1 h.출혈량350～1 000 ml,평균580 ml.21례환자술후균획4～26개월(평균10.3개월)수방.추체문융합시간약4～6개월,수방중추체고도무주실.무단정、단봉혹내치물송동、이위등병발증,신경공능균유1～2급개선.결론 지요괄응증선택합괄,후로소절구단절단측전방감압전주중건술구유조작안전간편、수술창상소、융합절단소、술후강복쾌적우점,시일충안전유효적수술방식.
Objective To investigate the feasibility and clinical effect of the posterior single segment anterolateral decompression and anterior column reconstruction in the treatment of thoracolumbar burst fractures. Methods A retrospective study was done on 21 patients with type Denis B thorocalumbar burst fractures who were treated by posterior approach minimal incision pedicle SCreW fixation,single segment anterolateral decompression and titanium mesh and bone graft from August 2007 to August 2009.There were 15 males and six males at mean age of 35.6 years(range,23-50 years).The involved segments included T12 in six patients,L1 in 11,L2 in three,and L3 in one.The preoperative spinal canal enemachment rate was 62.5%and the anterior-middle vertebral compression of all patients was less than 50%.CT scanning showed normal vertebral body and inferior endplate structure.The fracture reduction,graft fusion,neurological function recovery,correction loss,lumbar activities and adjacent lumbar disc degeneration were observed through preoperative,immediate postoperative and final follow up X-ray,CT and neurological examinations. Results The operation duration was 1.5-3.2 hours(average 2.1hours),with the bleeding of 350-1 000 ml(average 580 ml).All the patients were followed up for 4-26months(average 10.3 months),which showed that the vertebral fusion time was 4-6 months,with no loss of the vertebral height,implant breakage,loosening or extrusion.The nerve function was improved for 1-2 grades. Conclusions With correct selection of the indications,the posterior single segment anterolateral decompression and anterior column reconstruction is a reliable fixation,for it takes advantages of simple operation,minor trauma,less fusion segments and fast recovery.