CAJ | 학술논문

目的探讨经后路椎体次全切除三柱重建治疗不稳定性胸、腰椎单发爆裂型骨折的临床疗效.方法 2005年1月至2009年3月,采用该术式治疗不稳定性胸、腰椎单发爆裂型骨折患者30例,男22例,女8例；年龄17～58岁,平均36岁.手术采用后正中入路,切除伤椎的一侧椎板、椎弓根及关节突,创建后外侧通道,然后行椎体次全切,椎间植入钛网或人工骨笼,后路椎弓根内固定重建脊柱三柱的稳定性.随访时进行X线和CT检查,比较术前、术后和随访时的伤椎高度、Cobb角、椎管狭窄分级及植骨融合情况.结果 30例均获得随访,平均随访28个月(18～48个月).手术后胸、腰椎生理曲度恢复满意,Cobb角及伤椎高度与术前相比得到明显改善；椎管狭窄分级,术前2级8例、3级22例,术后均为0级；神经功能明显恢复,术后Frankel分级:A级1例、B级1例、C级3例、D级9例、E级16例.结论经后路椎体次全切除及三柱重建治疗不稳定性胸、腰椎单发爆裂型骨折是安全、有效的方法,并且具备前后联合入路手术的优势,为治疗不稳定胸、腰椎单发爆裂型骨折提供一个理想的选择.
목적 탐토경후로추체차전절제삼주중건치료불은정성흉、요추단발폭렬형골절적림상료효.방법 2005년1월지2009년3월,채용해술식치료불은정성흉、요추단발폭렬형골절환자30례,남22례,녀8례；년령17～58세,평균36세.수술채용후정중입로,절제상추적일측추판、추궁근급관절돌,창건후외측통도,연후행추체차전절,추간식입태망혹인공골롱,후로추궁근내고정중건척주삼주적은정성.수방시진행X선화CT검사,비교술전、술후화수방시적상추고도、Cobb각、추관협착분급급식골융합정황.결과 30례균획득수방,평균수방28개월(18～48개월).수술후흉、요추생리곡도회복만의,Cobb각급상추고도여술전상비득도명현개선；추관협착분급,술전2급8례、3급22례,술후균위0급；신경공능명현회복,술후Frankel분급:A급1례、B급1례、C급3례、D급9례、E급16례.결론 경후로추체차전절제급삼주중건치료불은정성흉、요추단발폭렬형골절시안전、유효적방법,병차구비전후연합입로수술적우세,위치료불은정흉、요추단발폭렬형골절제공일개이상적선택.
Objective To investigate the clinical effects of subtotal corpectomy and three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar fracture.Methods Between January 2005 and March 2009,30 patients with unstable thoracolumbar fractures were involved,among whom there were 22 males and 8 females,aged 17-58 years old (36 on average).There were 16 cases of falling injury and 14 cases of vehicle accident injury.The laminae of the injured vertebrae and adjacent vertebrae were exposed through posterior midline incision.Unilateral lamina and pedicle of the injured vertebra and relevant facet joints were resected to build a posterolateral working pathway after pedicle screws were put into the upper and lower vertebrae.Through this pathway a subtotal corpectomy was done and a titanium mesh or artificial bone with suitable size was implanted.The titanium mesh or artificial bone was fastened by compressing the pediele screws.The outcome of treatment was assessed by evaluation of the Cobb angle restoration,the reduction of canal compromise,and the fusion of implant between the upper and lower vertebrae.Results Thirty patients were followed up for an average of 28 months.The thoracolumbar vertebral curvature had fully recovered; The Cobb's angle,spinal canal index and the intervertebral space height had improved remarkably; The Frankel grade scores:A in 1 case,B in 1 case,C in 3 cases,D in 9 cases,and E in 16 cases.No patients developed such complications as break or mobilization of the pedicle screw.Conclusion Subtotal corpectomy and three-column reconstruction through single posterior approach is a safe and effective technique for the treatment of unstable thoracolumbar fracture.