CAJ | 학술논문

目的探讨经后路单侧伤椎置钉联合短节段椎弓根螺钉内固定治疗轻中度不稳定的胸腰椎骨折的手术治疗效果.方法回顾性分析2008年1月至2009年12月收治的26例载荷分享评分(LSC)为4～6分、单节段胸腰椎骨折并行单侧伤椎置钉联合短节段椎弓根螺钉内固定的患者临床资料.其中男性16例,女性10例,年龄39 ～ 60岁,平均47.3岁.LSC评分,4分2例,5分14例,6分10例.患者神经功能评定参照Frankel分级,C级2例,D级3例,E级21例.依据患者伤椎前缘高度比、矢状面Cobb角、神经功能情况、内固定失败情况、视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)进行疗效评价.结果患者随访时间13 ～ 26个月,平均18.6个月,无内固定失败发生.术前有神经功能不完全损害的5例患者中4例获得完全恢复,1例由术前C级部分恢复到D级.患者伤椎前缘高度由术前平均57.0％±6.3％恢复到术后94.6％±1.9％,末次随访时为93.1％±1.7％,差异有统计学意义(F=455.276,P＜0.05)；矢状面Cobb角由术前平均15.6°±4.7°恢复到术后1.1°±4.6°,末次随访维持在2.6°±5.2°,差异有统计学意义(F=34.623,P＜0.05).术后不同时间点之间比较差异均无统计学意义(P＞0.05).末次随访VAS平均为1.0±0.7,ODI为17.0±5.9.结论对于轻中度不稳定的胸腰椎骨折患者进行单侧伤椎置钉联合短节段椎弓根螺钉内固定治疗安全有效.
목적 탐토경후로단측상추치정연합단절단추궁근라정내고정치료경중도불은정적흉요추골절적수술치료효과.방법 회고성분석2008년1월지2009년12월수치적26례재하분향평분(LSC)위4～6분、단절단흉요추골절병행단측상추치정연합단절단추궁근라정내고정적환자림상자료.기중남성16례,녀성10례,년령39 ～ 60세,평균47.3세.LSC평분,4분2례,5분14례,6분10례.환자신경공능평정삼조Frankel분급,C급2례,D급3례,E급21례.의거환자상추전연고도비、시상면Cobb각、신경공능정황、내고정실패정황、시각모의량표(VAS)평분급Oswestry공능장애지수(ODI)진행료효평개.결과 환자수방시간13 ～ 26개월,평균18.6개월,무내고정실패발생.술전유신경공능불완전손해적5례환자중4례획득완전회복,1례유술전C급부분회복도D급.환자상추전연고도유술전평균57.0％±6.3％회복도술후94.6％±1.9％,말차수방시위93.1％±1.7％,차이유통계학의의(F=455.276,P＜0.05)；시상면Cobb각유술전평균15.6°±4.7°회복도술후1.1°±4.6°,말차수방유지재2.6°±5.2°,차이유통계학의의(F=34.623,P＜0.05).술후불동시간점지간비교차이균무통계학의의(P＞0.05).말차수방VAS평균위1.0±0.7,ODI위17.0±5.9.결론 대우경중도불은정적흉요추골절환자진행단측상추치정연합단절단추궁근라정내고정치료안전유효.
Objective To evaluate the efficacy of unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability. Methods Twenty-six patients with single segment thoracolumbar fracture received unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw from January 2008 to December 2009. There were 16 patients were male and 10 were female with an average age of 47.3 years (range from 39 to 60 years).Fracture severity score was constructed by using the load-sharing classification (4 points for 2 cases,5 points for 14 cases,6 points for 10 cases).By Frankel assessment system,2 cases were in grade C,3 in grade D,21 in grade E. The assessment included anterior vertebral body height,the sagittal Cobb angle,the restoration of nervous function,visual analogue score (VAS) and Oswestry disability index (ODI).Results The follow-up after the surgery was 13-26 months,with an average of 18.6 months.There were no fixation failure,defined as implant failure or ≥ 10°correction loss.The neurological status of 4 patients,who had an associated neurologic deficit preoperatively,was completely recovered. The Frankel grade of another case was re-rated D from the original C.The mean anterior vertebral body height increased from 57.0％ ± 6.3％ before the surgery to 93.1％ ± 1.7％ at the last follow-up( F =455.276,P ＜ 0.05 ).The sagittal Cobb angle decreased from 15.6° ± 4.7° before the surgery to 2.6° ± 5.2° at the last follow-up ( F =34.623,P ＜0.05).VAS and ODI were 1.0 ± 0.7 and 17.0 ± 5.9 at the last follow-up.Conclusion Unilateral pedicle screw fixation through the pedicle of fractured vertebra combined with the short segment of pedicle screw is effective for thoraclumbar fracture with mild to moderate instability.