CAJ | 학술논문

目的评价经后路椎体部分切除钛网植入联合椎弓根螺钉治疗胸腰段不稳定骨折的效果.方法采用单纯后侧入路切除部分椎体植入钛网并联合椎弓根螺钉内固定方法治疗8 例不稳定胸腰椎骨折.男6 例,女2 例,平均39.3 岁;T11骨折1 例,T12骨折3 例,L1骨折3 例,L2骨折1 例.根据Denis分型,本组8例均为三柱骨折.平均后凸成角26.6°,平均椎管占位77.4%,平均椎体高度丢失70.6%.对手术时间、术中失血量、手术并发症以及术后神经功能改善程度进行评价.结果 5 例术后神经功能较术前无明显改善;2 例ASIA评分由D提高到E,1 例由C提高到D,椎体正常序列基本恢复,术后局部后凸成角平均恢复到5°(0～14°).所有病例均未出现严重血管损伤以及神经症状加重等并发症.手术时间129～230 min,平均168 min.术中出血量1 650～3 650 mL,平均2 594mL.结论不稳定胸腰椎骨折可采用单纯后侧入路切除部分椎体植入钛网并联合椎弓根螺钉内固定治疗,该方法操作简单、并发症较少并能提供三柱固定.
목적 평개경후로추체부분절제태망식입연합추궁근라정치료흉요단불은정골절적효과.방법 채용단순후측입로절제부분추체식입태망병연합추궁근라정내고정방법 치료8 례불은정흉요추골절.남6 례,녀2 례,평균39.3 세;T11골절1 례,T12골절3 례,L1골절3 례,L2골절1 례.근거Denis분형,본조8례균위삼주골절.평균후철성각26.6°,평균추관점위77.4%,평균추체고도주실70.6%.대수술시간、술중실혈량、수술병발증이급술후신경공능개선정도진행평개.결과 5 례술후신경공능교술전무명현개선;2 례ASIA평분유D제고도E,1 례유C제고도D,추체정상서렬기본회복,술후국부후철성각평균회복도5°(0～14°).소유병례균미출현엄중혈관손상이급신경증상가중등병발증.수술시간129～230 min,평균168 min.술중출혈량1 650～3 650 mL,평균2 594mL.결론 불은정흉요추골절가채용단순후측입로절제부분추체식입태망병연합추궁근라정내고정치료,해방법 조작간단、병발증교소병능제공삼주고정.
Objective To evaluate the effect of three columns stabilization only through posterior approach in the treatment of unstable thoracolumbar fracture.Methods Eight patients(6 males and 2 females)with unstable thoracolumbar fracture were treated by the application of anterior titanium mesh and posterior pedicles screws stabilization instruments through only the posterior approach.All cases was identified as three column fracture according to Denis classification.preoperative spinal canal compromise was 77.4%(range 50%～92%),and the mean vertebral body height loss was 70.6%(range 55%～78%).The mean preoperative kyphotic deformity was 26.6°(range 20°～35°).Neurological improvement was assessed according to ASIA grading scale.We also recorded operation time,blood loss,complications.Results 5 cases have no neurological function improvement postoperatively.In 2 cases,the ASIA score improved from D to E and 1 case from C to D.The mean preoperative segmental kyphotic deformity of 26.6°(range 20°～35°) improved significantly to 5°(range 0°～14°) after surgery.The vertebral body restore the normal height.The operation time was median 174 min,range 130～215 min.The blood loss was median 2,594 mL,range 1 650～3 650 mL.There were no cases of vascular complication or neurological deterioration.Conclusion The application of anterior and posterior stabilization instruments through only the posterior approach is a satisfactory technique for the treatment of unstable thoracolumbar fracture.It is simple and can provide three-column fixation.