CAJ | 학술논문

目的:分析后路减压、过伸体位复位、椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折的临床疗效.方法:采用后路减压、过伸体位复位、椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折患者48例.手术前后测量骨折椎体前、后缘高度百分比、后凸畸形Cobb's角,定期随访并评定神经功能恢复情况.结果:术后伤椎椎体前缘高度及后凸畸形Cobb's角明显恢复(t=9.26,P＜0.01;t=7.35,P＜0.01),伤椎后缘高度较术前无明显变化(t=8.32,P＞0.05).随访6～36个月,平均25个月,患者平均伤椎后凸畸形Cobb's角及椎体前缘高度分别较术后丢失5%和8%.5例完全神经损伤者(Frankel A级)神经功能无明显恢复,24例不完全神经损伤者(Frankel A～D级)中21例(87.5%)神经功能恢复1级或以上.断钉1例,钉道松动1例,过度牵伸复位致神经损伤加重1例.结论:后路减压、过伸体位复位、椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折,能有效恢复椎体高度和生理弯曲,有利于恢复神经功能,但也存在断钉、钉道松动、伤椎高度及矫正角度丢失等问题.
목적:분석후로감압、과신체위복위、추궁근정봉계통내고정치료흉요추폭렬성골절적림상료효.방법:채용후로감압、과신체위복위、추궁근정봉계통내고정치료흉요추폭렬성골절환자48례.수술전후측량골절추체전、후연고도백분비、후철기형Cobb's각,정기수방병평정신경공능회복정황.결과:술후상추추체전연고도급후철기형Cobb's각명현회복(t=9.26,P＜0.01;t=7.35,P＜0.01),상추후연고도교술전무명현변화(t=8.32,P＞0.05).수방6～36개월,평균25개월,환자평균상추후철기형Cobb's각급추체전연고도분별교술후주실5%화8%.5례완전신경손상자(Frankel A급)신경공능무명현회복,24례불완전신경손상자(Frankel A～D급)중21례(87.5%)신경공능회복1급혹이상.단정1례,정도송동1례,과도견신복위치신경손상가중1례.결론:후로감압、과신체위복위、추궁근정봉계통내고정치료흉요추폭렬성골절,능유효회복추체고도화생리만곡,유리우회복신경공능,단야존재단정、정도송동、상추고도급교정각도주실등문제.
Objective:To study the clinical effect of posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system on burst thoracolumbar fracture.Method:48 patients with burst thoracolumbar fracture were treated with posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system.The heights of anterior and posterior border and kyphosis Cobb's angle of compressed vertebral bodies were measured before and after surgery.All patients were followed up regularly and the state of neurofunctional recovery was evaluatd.Results:The heights of anterior border and kyphosis Cobb's angle of compressed vertebral bodies restored obviously after surgery(t=9.26,P＜0.01;t=7.35,P＜0.01) and the heights of posterior border presented no obvious change after surgery (t=8.32,P＞0.05). The average follow-up period was 25 months(7-36 months) and the value of loss of mean height of anterior border and kyphosis Cobb's angle of compressed vertebral bodies were 5% and 8%,respectively. The neurofunction of 5 patients(Frankel A grade) didn't recover,while improvement of neurofunction at least 1 Frankel grade was found in 21 patients(Frankel A-D grade).Break of screw occurred in one case and loose of screw occurred in another case and damage of neurofunction aggravated in one case due to excess drawing.Conclusion:The method of posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system is effective for burst thoracolumbar fracture.It provides satisfactory restoration of height of vertebral bodies and physiologic postural contour and it facilitates recovery of neurofunction.However,it is associated with troubles of break of screw and loose of screw and loss of height and kyphosis Cobb's angle of compressed vertebral bodies.