CAJ | 학술논문

目的探讨经皮单节段经伤椎固定治疗胸腰椎爆裂骨折(AO分型A3.1和A3.2)的可行性、安全性和疗效.方法回顾分析2010年3- 12月收治的胸腰椎爆裂骨折(AO分型A3.1和A3.2)患者24例,采用经皮单节段椎弓根螺钉固定治疗.计算手术时间、出血量、术前术后视觉模拟评分( visual analogue scale,VAS)、伤椎椎体前缘高度与正常椎体比值和伤椎后凸Cobb角.结果经皮单节段固定手术时间(90±25) min,术中出血量(20±10)ml.伤椎前缘高度与正常椎体比值术前为 56.5±10.1,术后1周为92.3±12.2,术后1年随访时为90.2±11.1；伤椎后凸Cobb角术前为(16.5±5.2)°,术后1周为(7.3±2.4)°,术后1年随访时为(7.9±3.5)°:VAS术前为(7.0±1.2)分,术后1周为(1.2±0.7)分,术后1年随访时为(1.1±0.5)分.术后1周伤椎椎体前缘高度比值较术前明显增高(P＜0.05),1年随访时伤椎椎体前缘高度比值较术前也明显增高(P＜0.05),术后1周伤椎体前缘高度比值与术后1年相比,差异无统计学意义(P＞0.05).伤椎后凸Cobb角术后1周及1年随访时较术前明显减小(P＜0.05).术后1周及1年随访时VAS较术前均有明显改善.结论后路经皮经伤椎单节段固定治疗胸腰椎爆裂骨折(AO分型A3.1和A3.2)安全、有效,但不适用于椎体压缩严重的胸腰椎爆裂骨折.
목적 탐토경피단절단경상추고정치료흉요추폭렬골절(AO분형A3.1화A3.2)적가행성、안전성화료효.방법 회고분석2010년3- 12월수치적흉요추폭렬골절(AO분형A3.1화A3.2)환자24례,채용경피단절단추궁근라정고정치료.계산수술시간、출혈량、술전술후시각모의평분( visual analogue scale,VAS)、상추추체전연고도여정상추체비치화상추후철Cobb각.결과 경피단절단고정수술시간(90±25) min,술중출혈량(20±10)ml.상추전연고도여정상추체비치술전위 56.5±10.1,술후1주위92.3±12.2,술후1년수방시위90.2±11.1；상추후철Cobb각술전위(16.5±5.2)°,술후1주위(7.3±2.4)°,술후1년수방시위(7.9±3.5)°:VAS술전위(7.0±1.2)분,술후1주위(1.2±0.7)분,술후1년수방시위(1.1±0.5)분.술후1주상추추체전연고도비치교술전명현증고(P＜0.05),1년수방시상추추체전연고도비치교술전야명현증고(P＜0.05),술후1주상추체전연고도비치여술후1년상비,차이무통계학의의(P＞0.05).상추후철Cobb각술후1주급1년수방시교술전명현감소(P＜0.05).술후1주급1년수방시VAS교술전균유명현개선.결론 후로경피경상추단절단고정치료흉요추폭렬골절(AO분형A3.1화A3.2)안전、유효,단불괄용우추체압축엄중적흉요추폭렬골절.
Objective To investigate the feasibility,safety and therapeutic effects of minimally invasive percutaneous mono-segment pedicle instrumentation in treating thoracolumbar burst fractures ( AO classification:A 3.1 and A 3.2 ).Methods Twenty-four inpatients with thoracolumbar burst fractures (AO classification:A 3.1 and A 3.2) treated with percutaneous mono-segment pedicle instrumentation from March 2010 to December 2010 were retrospectively studied.The operation time,blood loss,pre-and post-operative visual analogue scale ( VAS),ratio of anterior height between compressed vertebral body and normal vertebral body and vertebral kyphotic Cobb' s angle were evaluated.Results The operation lasted for (90 ± 25) minutes,with intraoperative blood loss of (20 ± 10) ml.The rate of anterior body height rose from pre-operative (56.5 ± 10.1 ) to (92.3 ± 12.2) one week post-operatively and to (90.2 ± 11.l)at the follow-up one year later.The vertebral kyphotic Cobb' s angle was pre-operative ( 16.5 ± 5.2) °,which was reduced to ( 7.3 ± 2.4 )° at oneweek after surgery and ( 7.9 ± 3.5 )° at the follow-up one year later respectively.The VAS scored ( 7.0 ± 1.2) points before surgery,( 1.2 ±0.7) points at one week after surgery and ( 1.1 ± 6..5) points at the follow-up one year later.The ratio of anterior body height at one week after surgery and at the follow-up one year later were both obviously higher than that before surgery (P ＜ 0.05 ),but the ratio one week postoperatively showed no significant difference in comparison with that one year postoperatively (P ＞0.05).The kyphotic Cobb' s angle had significant decrease at one week after surgery and at the follow-up one year later,as compared with that before operation (P ＜0.0 5).Also,the VAS score showed marked improvement at one week after surgery and at the follow-up one year later.Conclusions Minimally invasive percutaneous mono-segmental pedicle instrumentation is effective and safe for thoracolumbar burst fractures (AO classification:A 3.1and A 3.2),but it is not suitable for thoracolumbar burst fracture with severely compressed vertebra.