CAJ | 학술논문

目的探讨微创技术在胸腰段骨折的应用及疗效.方法回顾性分析2005年2月至2010年6月采用微创手术治疗并有随访资料的胸腰段骨折患者共183例,男性126例,女性57例;年龄18～68岁,平均38.9岁.T11 22例,T12 61例,L1 71例,L2 29例.骨折按Gertzbein分型,A型145例,B型34例,C型4例;Load-sharing评分,4分51例,5分56例,6分17例,7分12例,8分24例,9分23例.根据微创手术策略选择不同的手术方法,采用经皮椎弓根螺钉内固定术( MIPPSO)治疗22例,小切口肌间隙椎弓根螺钉内固定术( SISPSO)治疗102例,胸腔镜或头灯光源辅助的小切口胸腰椎前路手术(SIATS)治疗31例,后路小切口270°减压重建术(270° DRS)治疗28例.Frankel 分级评定术后神经功能恢复情况,比较伤椎Cobb角的矫正和丢失及评估椎管减压范围及愈合情况.结果 183例患者均一期完成手术,术后随访12 ～60个月,平均35个月.MIPPSO治疗患者的手术时间为52～100 min,术中出血量为35～55 ml;SISPSO治疗患者的手术时间为48 ～ 68 min,术中出血量45～65 ml;两种术式治疗患者的Cobb角矫正8°～19°.SIATS手术治疗患者的手术时间为140～220 min,术中出血量160～1500 ml,术后X线检查显示脊柱序列和生理曲度基本恢复正常,Cobb角矫正15° ～25°;术后出现肺不张1例,股外侧皮神经损害1例,经治疗后症状消失.270° DRS治疗患者的手术时间为160 ～ 280 min,术中出血700～4700 ml,术后Cobb角矫正15° ～28°,1例术后神经症状加重.所有病例术后随访未发生内固定器松脱、移位及断裂,植骨均融合.所有椎管占位病例术后CT显示椎管腔扩大,减压彻底.除1例术后神经症状加重外,其余术前不完全性神经损伤患者术后神经功能Frankel分级均恢复1级或以上.结论合理运用微创技术治疗胸腰段骨折效果满意.
목적 탐토미창기술재흉요단골절적응용급료효.방법 회고성분석2005년2월지2010년6월채용미창수술치료병유수방자료적흉요단골절환자공183례,남성126례,녀성57례;년령18～68세,평균38.9세.T11 22례,T12 61례,L1 71례,L2 29례.골절안Gertzbein분형,A형145례,B형34례,C형4례;Load-sharing평분,4분51례,5분56례,6분17례,7분12례,8분24례,9분23례.근거미창수술책략선택불동적수술방법,채용경피추궁근라정내고정술( MIPPSO)치료22례,소절구기간극추궁근라정내고정술( SISPSO)치료102례,흉강경혹두등광원보조적소절구흉요추전로수술(SIATS)치료31례,후로소절구270°감압중건술(270° DRS)치료28례.Frankel 분급평정술후신경공능회복정황,비교상추Cobb각적교정화주실급평고추관감압범위급유합정황.결과 183례환자균일기완성수술,술후수방12 ～60개월,평균35개월.MIPPSO치료환자적수술시간위52～100 min,술중출혈량위35～55 ml;SISPSO치료환자적수술시간위48 ～ 68 min,술중출혈량45～65 ml;량충술식치료환자적Cobb각교정8°～19°.SIATS수술치료환자적수술시간위140～220 min,술중출혈량160～1500 ml,술후X선검사현시척주서렬화생리곡도기본회복정상,Cobb각교정15° ～25°;술후출현폐불장1례,고외측피신경손해1례,경치료후증상소실.270° DRS치료환자적수술시간위160 ～ 280 min,술중출혈700～4700 ml,술후Cobb각교정15° ～28°,1례술후신경증상가중.소유병례술후수방미발생내고정기송탈、이위급단렬,식골균융합.소유추관점위병례술후CT현시추관강확대,감압철저.제1례술후신경증상가중외,기여술전불완전성신경손상환자술후신경공능Frankel분급균회복1급혹이상.결론 합리운용미창기술치료흉요단골절효과만의.
Objective To study the therapeutic method and effect of minimally invasive surgery for the thoracolumbar fractures.Methods A retrospective review of the minimally invasive surgically treatment thoracolumbar fractures from February 2005 to June 2010 was performed.There were 183 cases,126 males and 57 females,aged 18 to 68 years,average 38.9 years.The involved levels of fractures were T11 in 22,T12 in 61,L1 in 71,L2 in 29.According to Gertzbein classification,145 cases were type A fractures,34 cases were type B fractures,4 cases were type C fractures; According to Load-sharing score,51 cases were 4 scores,56 cases were 5 scores,17 cases were 6 scores,12 cases were 7 scores,24 cases were 8 scores,23 cases were 9 scores.Different surgical methods were selected according to the minimally invasive surgical strategy,22 patients were treated with the minimally invasive percutaneous pedicle screws osteosynthsis ( MIPPSO group),102 patients were treated with the small-incision pedicle screws osteosynthsis ( SISPSO group),31 patients were treated with the small incision anterior thoraciclumbar surgery (SIATS group )assisted by thoracoscope or headlight,and 28 patients were treated with the 270° decompression and reconstruction surgery (270° DRS group) via a posterior small incision.Preoperative and postoperative neurological status,the correction and loss of Cobb' s angle,the decompression scope of spinal canal,the location and union of bone graft were followed up and reviewed.Results All of 183 cases had successful surgery and were followed up.In the MIPPSO group,operative time was 52-100 min,blood loss was 35- 55 ml.In the the SISPSO group,operative time was 48-68 min,the blood loss was 45-65 ml the correction of Cobb's angle in the two groups was 8°-19°.In the SLATS group,operative time was 140-220 min,the blood loss was 160-1500 ml the correction of Cobb's angle was 15°-25°,1 case had pleural effusion,1 had lateral femoral cutaneous nerve damage,the complications disappeared after treatment.In the 270° DRS group the operative time was 160-280 min,the blood loss was 700-4700 ml,the correction of Cobb's angle was 15°-28°.The spinal canal mass was removed,the spinal canal was enlarged and completely decompressed.Neurological status improved in all of the preoperative incomplete paraplegia patients except 1 case whose neurological symptoms aggravated.Conclusion It is satisfactory that the minimally invasive surgical strategy was rational used in the treatment of thoracolumbar fractures.