CAJ | 학술논문

目的通过对比后路间接减压内固定术(POIT)、后路椎板切除减压内固定术(POLT)与前路减压内固定术(ADIT)治疗Magerl B型胸腰椎骨折的临床结果 ,探讨Magerl B型胸腰椎骨折的治疗要点.方法 2005年11月至2008年1月回顾性分析69例Magerl B型胸腰椎骨折患者资料,其中POIT组23例,POLT组25例,ADIT组21例.3组患者的年龄、性别比、术前伤椎前缘高度比值、伤椎后缘高度比值、Cobb角等比较差异均无统计学意义(P>0.05).比较3组患者手术时间、术中术后出血量、术中术后并发症、术后后凸畸形矫正、椎管占位复位及神经损伤恢复程度. 结果 69例患者术后获20～25个月(平均22个月)随访.POIT组、POLT组、ADIT组手术时间分别为(90±15)、(123±30)、(153±30)min;术中出血量分别为(212±25)、(407±47)、(532±147)mL;术后出血引流量分别为(154±11)、(218±27)、(271±53)mL.术后1年POIT组伤椎前、后缘缘高度比值分别为85.2%±4.0%和96.4%±4.0%,均优于POLT组,差异有统计学意义;且POIT组和POLT组术后1年伤椎前、后缘高度值及Cobb与术前比较均有明显改善,差异有统计学意义(P<0.05).术后Cobb角恢复优于POLT组和ADIT组,差异均有统计学意义(P<0.05).术后1年神经损伤恢复、纠正丢失程度,3组间比较差异无统计学意义(P>0.05). 结论 Magerl B型胸腰椎骨折在后纵韧带复合体完整情况下是POIT的适应证;POIT对该型骨折复位效果优于POLT及ADIT,且创伤小、并发症发生率低,但其远期效果需要进一步临床研究.
목적 통과대비후로간접감압내고정술(POIT)、후로추판절제감압내고정술(POLT)여전로감압내고정술(ADIT)치료Magerl B형흉요추골절적림상 결과 ,탐토Magerl B형흉요추골절적치료요점.방법 2005년11월지2008년1월회고성분석69례Magerl B형흉요추골절환자자료,기중POIT조23례,POLT조25례,ADIT조21례.3조환자적년령、성별비、술전상추전연고도비치、상추후연고도비치、Cobb각등비교차이균무통계학의의(P>0.05).비교3조환자수술시간、술중술후출혈량、술중술후병발증、술후후철기형교정、추관점위복위급신경손상회복정도. 결과 69례환자술후획20～25개월(평균22개월)수방.POIT조、POLT조、ADIT조수술시간분별위(90±15)、(123±30)、(153±30)min;술중출혈량분별위(212±25)、(407±47)、(532±147)mL;술후출혈인류량분별위(154±11)、(218±27)、(271±53)mL.술후1년POIT조상추전、후연연고도비치분별위85.2%±4.0%화96.4%±4.0%,균우우POLT조,차이유통계학의의;차POIT조화POLT조술후1년상추전、후연고도치급Cobb여술전비교균유명현개선,차이유통계학의의(P<0.05).술후Cobb각회복우우POLT조화ADIT조,차이균유통계학의의(P<0.05).술후1년신경손상회복、규정주실정도,3조간비교차이무통계학의의(P>0.05). 결론 Magerl B형흉요추골절재후종인대복합체완정정황하시POIT적괄응증;POIT대해형골절복위효과우우POLT급ADIT,차창상소、병발증발생솔저,단기원기효과수요진일보림상연구.
Objective To compare clinical outcomes of posterior open-reduction and indirect-decompression technique (POIT), posterior open-reduction and laminectomy technique (POLT), and anterior decompression and internal fixation technique (ADIT) in the treatment of thoracolumbar fractures of Magerl type B. Methods A retrospective study was conducted of the 69 patients who had been treated in our department for thoracolumbar fractures from November 2005 to January 2008. Of them, 23 cases were treated with POIT, 25 with POLT and 21 with ADIT. Comparisons were conducted between the 3 groups in operation time, intra-and pest-operative blood loss, complications, reduction of kyphosis, vertebral channel occupation and neural recovery. Results The patients were followed up from 20 to 25 months, with an average of 22 months. The operation time in POIT group was 90±15 (78 to 119) min, 123±30 (93 to 156) min in POLT group and 153±30(127 to 186)min in A DIT group. In the 3 groups, the average intra-operative blood losses were 212±25 mL, 407±47 mL and 532±147 mL respectively, while the post-operative blood losses 154±11 mL, 218±27 mL and 271±53 mL respectively. Fewer complications happened in the POIT group than in the POLT and ADIT groups. There were no statistical differences in the recovery of nerve injury and the reduction loss between the 3 groups one year after operation. Conclusions POIT may be an appropriate treatment for the thoracolumbar fracture of Magerl type B when the posterior ligaments are not injured. POIT may have better clinical outcomes than POLT and ADIT, but its long-term effects need further investigation.