CAJ | 학술논문

目的探讨经骨折椎行椎弓根螺钉固定对胸腰椎骨折复位及维持复位的可行性及效果.方法对2003年1月-2006年10月收治的43例胸腰椎骨折患者进行回顾性研究.入选标准:T_(12)～L_2单椎体骨折;骨折椎椎弓根完整;下终板无骨折.全部患者均在伤后10 d内手术.骨折椎加用椎弓根螺钉固定23例(A组),其中男15例,女8例;平均年龄45岁(19～77岁).传统4钉固定20例(B组),其中男11例,女9例;平均年龄42岁(22～67岁).A组首先固定骨折椎与其尾侧椎,再在骨折椎与头侧椎之间撑开.结果手术前后骨折椎尾侧椎间隙前缘高度的变化A组(0.035±0.042)小于B组(0.061±0.036),差异有统计学意义(P<0.05).A组Cobb角的变化为(15.8±7.8)°,B组为(13.1±5.2)°,两组差异无统计学意义.34例得到平均15个月(11～24个月)的随访,末次随访时Cobb角A组平均丢失5.4°,B组平均丢失8.9°,两组比较,差异有统计学意义(P<0.05).A组有1例同定杆断裂,B组2例螺钉断裂.结论对部分胸腰椎骨折在骨折椎应用椎弓根螺钉可以增强后路短节段固定系统的牢固性,避免骨折椎尾侧椎间隙的过度撑开,改善应力分布,减少矫正度丢失.
목적 탐토경골절추행추궁근라정고정대흉요추골절복위급유지복위적가행성급효과.방법 대2003년1월-2006년10월수치적43례흉요추골절환자진행회고성연구.입선표준:T_(12)～L_2단추체골절;골절추추궁근완정;하종판무골절.전부환자균재상후10 d내수술.골절추가용추궁근라정고정23례(A조),기중남15례,녀8례;평균년령45세(19～77세).전통4정고정20례(B조),기중남11례,녀9례;평균년령42세(22～67세).A조수선고정골절추여기미측추,재재골절추여두측추지간탱개.결과 수술전후골절추미측추간극전연고도적변화A조(0.035±0.042)소우B조(0.061±0.036),차이유통계학의의(P<0.05).A조Cobb각적변화위(15.8±7.8)°,B조위(13.1±5.2)°,량조차이무통계학의의.34례득도평균15개월(11～24개월)적수방,말차수방시Cobb각A조평균주실5.4°,B조평균주실8.9°,량조비교,차이유통계학의의(P<0.05).A조유1례동정간단렬,B조2례라정단렬.결론 대부분흉요추골절재골절추응용추궁근라정가이증강후로단절단고정계통적뢰고성,피면골절추미측추간극적과도탱개,개선응력분포,감소교정도주실.
Objective To evaluate the feasibility and outcome of transpedicular screw fixation in fracture reduction and maintenance of reduction for thoracolumbar fractures.Methods The clinical data of 43 patients with thoracolumbar fractures admitted to Orthopedic Trauma Hospital of Qingdao from January 2003 to December 2006 were retrospectively analyzed.The inclusion criteria were as follow;sin-gle vertebral fracture involving T_(12)-L_2, integrated pedicle and no inferior endplate fracture.All patients received operation within 10 days after injury.Three-level fixation at fractured vertebra plus pedicle screw fixation was performed in 23 patients (Group A) including 15 males and 8 females, at mean age of 45 years (19-77 years).Traditional two-level fixation was done on the other 20 patients (Group B) inclu-ding 11 males and 9 females, at mean age of 42 years (22-67 years).In Group A, the transpedicular screws fixing the fractured vertebra and cephal vertebra were distracted after locking the transpedicular screw of the fracture vertebra and caudal vertebra.Results The height of the anterior edge of the cau-dal disc in Group B was 0.035 ±0.042, greater than 0.061 ±.036 in Group A, with statistical differ-ence (P < 0.05).There was no statistical difference in the changes of Cobb angle after the operation be-tween (915.8 ±7.8)°in Group A and (13.1±5.2)°in Group B.34 patients were followed up for an average period of 15 months (11-24 months) , which showed smaller Cobb angle in Group A (5.4°compared with Group B (8.9°)(P <0.05).There was one patient with screw breakage in Group A and two in Group B.Conclusion Transpedicular screws can enhance the stability of the posterior short-segment instrumentation, avoid over-distraction of the caudal discs, improve stress distribution and lessen loss of correction for some thoracolumbar fractures.