CAJ | 학술논문

目的探讨胸腰椎骨折经后路切除伤椎的可行性及临床效果.方法 2006年4月至2007年6月,经后路椎弓根钉内固定、伤椎切除及钛网骨移植椎问融合术治疗胸腰椎爆裂骨折27例,男2l例,女6例;年龄22～53岁,平均33.6岁.骨折节段Tu 3例,T12 7例,L1 9例,L2 6例,L3 1例,L1例.采用Frankel分级标准评定神经功能恢复情况.术前神经损伤程度按Frankel分级标准:A级8例,B级13例,C级6例.结果 27例患者术后获3～12个月(平均8.2个月)随访.术后压迫脊髓的骨块完全切除,Cobb角平均3.2°,脊柱恢复牛理曲度.术前19例不完全性神经损伤患者神经功能恢复一级或一级以上;8例完伞性神经损伤患者中,5例无改善,2例神经功能由A级恢复至C级,1例由A级恢复至D级.结论对于三柱损伤的急性胸腰椎骨折患者,应用经后路椎弓根钉内固定、伤椎切除及钛网骨移植椎间融合术治疗,能彻底切除压迫脊髓的前方骨块,具有骨折复位满意、手术创伤小及并发症少等优点.
목적 탐토흉요추골절경후로절제상추적가행성급림상효과.방법 2006년4월지2007년6월,경후로추궁근정내고정、상추절제급태망골이식추문융합술치료흉요추폭렬골절27례,남2l례,녀6례;년령22～53세,평균33.6세.골절절단Tu 3례,T12 7례,L1 9례,L2 6례,L3 1례,L1례.채용Frankel분급표준평정신경공능회복정황.술전신경손상정도안Frankel분급표준:A급8례,B급13례,C급6례.결과 27례환자술후획3～12개월(평균8.2개월)수방.술후압박척수적골괴완전절제,Cobb각평균3.2°,척주회복우리곡도.술전19례불완전성신경손상환자신경공능회복일급혹일급이상;8례완산성신경손상환자중,5례무개선,2례신경공능유A급회복지C급,1례유A급회복지D급.결론 대우삼주손상적급성흉요추골절환자,응용경후로추궁근정내고정、상추절제급태망골이식추간융합술치료,능철저절제압박척수적전방골괴,구유골절복위만의、수술창상소급병발증소등우점.
Objective To investigate the feasibility and clinical outcome of transpedicular corpec-tomy with Meshcage and pedicle screw fixation in the treatment of thoracolumbar/lumbar burst fractures.Methods Twenty-seven patients with thoracolumbar/lumbar burst fracture were treated by posterior pedicle screw reduction and corpectomy with titanic Meshcage implantation from April 2006 to June 2007.This group included 21 males and 6 females, with an average age of 33.6(22 to 53)years.There were 3 cases of T11 fracture, 7 T12 fracture, 9 L1 fracture, 6 L2 fracture, 1 L3 fracture, and 1 L4 fracture.Pre- and post-operative data were recorded in detail.According to the preoperative X-ray images, the average spinal canal occupational ratio was 70.5% and average segmental Cobb angle was 32.2°.Neurological functions were evaluated by Frankel Grading system.Results All patients were followed up for 3 to 12 months, with a mean period of 8.2 months.After the blocks compressing the nerve were removed, the postoperative Cobb angle averaged 3.2° and the spinal curve was restored.Of the 8 patients with complete neural lesion, 2 had 2-grade improvement, 1 had 3-grade improvement but the other 5 had none.The other 19 patients who had suffered incomplete nerve injury showed improvement to different extents.There were no other complications in this group.Conclusions Transpedicular corpectomy, Meshcage and pedicle screw internal fixation and autogenous bone graft can be a very good treatment for thoracolumbar/lumbar burst fractures, because it can spare the trouble of surgery through combined anterior and posterior approaches, resulting in satisfactory reduction, complete decompression, little operative invasion and few complications.