CAJ | 학술논문

目的探讨经椎旁肌间隙入路治疗胸腰椎骨折的手术方法及其与传统手术方法的比较.方法 2006年10月至2008年10月,52例无神经损伤表现的胸腰椎骨折患者被纳入研究.依据Denis 骨折分型,压缩型骨折17例,爆裂型骨折35例,其中男37例,女15例;年龄18～59岁,平均46.5岁.T4骨折1例,T7骨折2例,T8骨折1例,T10骨折3例,T11骨折5例,T12骨折14例,L1骨折16例,L2骨折9例,L3骨折1例.影像学检查示:椎管内占位＜1/3,突入椎管骨块均匀完整,无碎裂及翻转.患者依次纳入研究,分为两组,其中20例患者采用传统后正中入路,其他32例患者采用经椎旁肌间隙入路,均行后路椎弓根螺钉固定.结果两组患者在性别、年龄、损伤节段、受伤至手术时间及随访时间方面比较,差异均无统计学意义.经肌间隙入路较传统后正中入路在手术时间、术中出血量、引流放置时间、术后引流量、术后下地时间,疼痛视觉模拟评分及Oswestry功能障碍指数等方面具有显著优势,两组间比较各项指标差异均有统计学意义.至2009年10月,所有患者均获得随访,平均时间21.5个月(12～36个月),所有患者伤椎椎体高度均无丢失,内固定无松动、断裂.结论与传统手术方法相比,经椎旁肌间隙入路治疗胸腰椎骨折可完整保留脊柱后方复合体结构,具有创伤小、出血少和恢复快等优点,是一种安全实用的手术方法,疗效满意.
목적 탐토경추방기간극입로치료흉요추골절적수술방법급기여전통수술방법적비교.방법 2006년10월지2008년10월,52례무신경손상표현적흉요추골절환자피납입연구.의거Denis 골절분형,압축형골절17례,폭렬형골절35례,기중남37례,녀15례;년령18～59세,평균46.5세.T4골절1례,T7골절2례,T8골절1례,T10골절3례,T11골절5례,T12골절14례,L1골절16례,L2골절9례,L3골절1례.영상학검사시:추관내점위＜1/3,돌입추관골괴균균완정,무쇄렬급번전.환자의차납입연구,분위량조,기중20례환자채용전통후정중입로,기타32례환자채용경추방기간극입로,균행후로추궁근라정고정.결과 량조환자재성별、년령、손상절단、수상지수술시간급수방시간방면비교,차이균무통계학의의.경기간극입로교전통후정중입로재수술시간、술중출혈량、인류방치시간、술후인류량、술후하지시간,동통시각모의평분급Oswestry공능장애지수등방면구유현저우세,량조간비교각항지표차이균유통계학의의.지2009년10월,소유환자균획득수방,평균시간21.5개월(12～36개월),소유환자상추추체고도균무주실,내고정무송동、단렬.결론 여전통수술방법상비,경추방기간극입로치료흉요추골절가완정보류척주후방복합체결구,구유창상소、출혈소화회복쾌등우점,시일충안전실용적수술방법,료효만의.
Objective To evaluate the posterior paraspinal muscle approach in the treatment of thoracic and lumbar spine fractures and compare this method with the conventional approach.Methods From October 2006 to October 2008,a total of 52 cases of non-neurological symptoms patients with thoracic and lumbar spine fractures were included in the study,including 37 males and 15 females with an average of 46.5 years (range,18-59 years).According to the Denis fracture classification,there were 17 compression fractures and 35 burst fractures with spinal space-occupying less than 1/3,including 1 case with T4 fracture,2 with T7 fracture,1 with T8 fracture,3 with T10 fracture,5 with Tn fracture,14 with T12 fracture,16 with L1fracture,9 with L2 fracture,and 1 with L3 fracture.The patients were divided into two groups,with 20 cases treated with the traditional approach and the other 32 cases with the posterior paraspinal muscle approach.All the patients were given pedicle screw fixation.Results No significant differences were found in terms of gender,age,injured segment,operation time and follow-up period between the two groups.Compared to the traditional approach,the posterior paraspinal muscle approach was significantly advantageous in terms of time,the amount of bleeding,postoperative drainage,duration of recumbence,pain visual analogue score and Oswestry disability index after the surgery.All patients were followed up for average 21.5 months (range,12-36 months).Till the last follow-up,all patients with vertebral fractures were healed.No loosening or breaking of internal fixation was observed.Conclusion The posterior paraspinal muscle approach for thoracic and lumbar spine fractures,retaining the posterior ligament complex,is an effective and minimally invasive treatment,with less trauma,less bleeding,the advantages of reliable clinical results.