CAJ | 학술논문

目的探讨并总结后路长节段经椎弓根螺钉内固定在手术治疗胸腰椎骨折脱位中的应用价值和经验.方法笔者对2007年7月-2010年3月所收治的27例胸腰椎骨折合并脱位的患者采用后路复位、长节段椎弓根螺钉内周定,其中男性20例,女性7例,平均年龄35岁,采用后路手术,在骨折椎体的上、下各2个椎体置入椎弓根螺钉,并结合后路减压及植骨融合.结果术后随访7～25个月,平均14个月,在所有患者中,25例脱位椎体基本复位,脊柱序列恢复正常,1例侧方脱位未能完全纠正,另有1例在术后20 d手术未能完全纠正前后移位.术后随访Cobb角丢失平均3°,与术后即刻相比,椎体高度明显丢失,本组病例发生螺钉松动1例,无再脱位和继发性后凸畸形,无内固定断裂,无死亡病例.结论对于不稳定的胸腰椎骨折脱位患者,采用后路长节段经椎弓根螺钉固定技术,操作相对简单,创伤小,可以达到骨折及脱位椎体的良好复位,能有效地预防远期椎体高度再丢失以及后凸畸形的发生,具有一定的临床应用价值.
목적 탐토병총결후로장절단경추궁근라정내고정재수술치료흉요추골절탈위중적응용개치화경험.방법 필자대2007년7월-2010년3월소수치적27례흉요추골절합병탈위적환자채용후로복위、장절단추궁근라정내주정,기중남성20례,녀성7례,평균년령35세,채용후로수술,재골절추체적상、하각2개추체치입추궁근라정,병결합후로감압급식골융합.결과 술후수방7～25개월,평균14개월,재소유환자중,25례탈위추체기본복위,척주서렬회복정상,1례측방탈위미능완전규정,령유1례재술후20 d수술미능완전규정전후이위.술후수방Cobb각주실평균3°,여술후즉각상비,추체고도명현주실,본조병례발생라정송동1례,무재탈위화계발성후철기형,무내고정단렬,무사망병례.결론 대우불은정적흉요추골절탈위환자,채용후로장절단경추궁근라정고정기술,조작상대간단,창상소,가이체도골절급탈위추체적량호복위,능유효지예방원기추체고도재주실이급후철기형적발생,구유일정적림상응용개치.
Objective To discuss the value of the posterior long segments pedicle screws fixation in surgical treatment of thoracolumbar fracture-dislocation,and summarize the experience.Method s We reviewed the clinical information of 27 cases of thoracolumbar fracture-dislocation since July 2007 to March 2010; all the cases were treated with the posterior long segments pedicle screws fixation.In these cases,20were male,7 were female.And the age ranged from 18 to 58 years old (average age was 35 years).The posterior approach was used,and the pedicle screws were inserted into the 2 vertebrae above and below the fractured vertebrae.Posterior decompression and bone grafts for fusion were also accomplished during the operation.Results Follow-up ranged from 7 to 25 months,averaging 14 months.Completely restoration of the dislocation was got in 25 cases and the spine sequence resumed to nearly normal.One case with lateral dislocation failed to complete correction; another 1 case operated 20 days after surgery failed to complete correction of forward dislocation.At the last follow-up,the mean Cobb angle loss was 3 degrees,the height of the vertebral had obvious loss compared with that of post-operation.The loosen of screw nut was found during the follow-up,but no dislocation and secondary deformity were observed after fixation.There was no death,no infection.Conclusions The technique of posterior long segments pedicle screw fixation is of great value in the clinical applications,since it has the following advantages:the operation is simple,trauma is small,the fixation is firm,good restoration of fracture and dislocations can be easily got,and most importantly,it can effectively prevent long-term vertebral height loss and the backward protruding deformity.