CAJ | 학술논문

目的探讨后路减压内固定治疗中上胸椎骨折脱位的方法及效果.方法 2002年9月至2007年9月采用后路手术治疗中上胸椎骨折脱位21例.其中压缩性骨折5例,爆破型骨折4例,骨折脱位12例;完全性瘫痪12例,不完全性瘫痪9例.本组减压复位后均采用椎弓根螺钉系统固定,骨折块突入椎管者,行侧后方骨折块复位或摘除减压.观察患者手术时间、出血量,测量手术前后胸椎滑移程度及椎间隙夹角.以Frankel评分系统评价神经功能.结果本组患者随访0.5～5.0(2.5±0.5)年.术前Frankel评分(1.0±0.1)分,术后(1.3±0.1)分;其中不完全性瘫痪者术前评分(2.2±0.2)分,术后(3.1±0.2)分.术后椎间隙高度、椎间隙夹角及滑移百分比较术前改善(P＜0.05).内植物无松脱或移位.结论中上胸椎骨折脱位脊髓损伤程度重,预后差.不稳定性骨折应及时行融合及内固定术,合并有不完全性脊髓损伤者应同时行减压手术.早期后路手术,患者能获得满意的复位和即刻稳定性,脊髓功能获不同程度改善.
목적 탐토후로감압내고정치료중상흉추골절탈위적방법급효과.방법 2002년9월지2007년9월채용후로수술치료중상흉추골절탈위21례.기중압축성골절5례,폭파형골절4례,골절탈위12례;완전성탄탄12례,불완전성탄탄9례.본조감압복위후균채용추궁근라정계통고정,골절괴돌입추관자,행측후방골절괴복위혹적제감압.관찰환자수술시간、출혈량,측량수술전후흉추활이정도급추간극협각.이Frankel평분계통평개신경공능.결과 본조환자수방0.5～5.0(2.5±0.5)년.술전Frankel평분(1.0±0.1)분,술후(1.3±0.1)분;기중불완전성탄탄자술전평분(2.2±0.2)분,술후(3.1±0.2)분.술후추간극고도、추간극협각급활이백분비교술전개선(P＜0.05).내식물무송탈혹이위.결론 중상흉추골절탈위척수손상정도중,예후차.불은정성골절응급시행융합급내고정술,합병유불완전성척수손상자응동시행감압수술.조기후로수술,환자능획득만의적복위화즉각은정성,척수공능획불동정도개선.
Objective To assess the clinical effect and methods of posterior decompress and fixation for upper-middle thoracic fracture and dislocation. Methods Between September 2002 and September 2007,21 patients suffered from upper-middle thoracic fracture and dislocation were treated with posterior approach, which comprising 5 patients with compressed fracture,4 patients with burst fracture, 12 patients with fracture and dislocation. There were 12 cases companied by complete paraplegia, and 9 cases companied by incomplete paraplegia. All cases adapted to pedicle screw fixation system after decompression and reduction. Reduction or removal of fragments was done through posterior-lateral of the spinal canal for patients with fragments migrated into the spinal canal. The operation time,blood loss volume,preand postoperative transverse displacement degree and angle of the injured vertebra were recorded. The neurological function was assessed by Frankel criteria. Results The patients was followed up for (2.5 ± 0.5 ) years. The Frankel score increased from ( 1.0 ± 0.1 ) scores preoperatively to ( 1.3 ± 0.1 ) scores postoperatively. The incomplete paraplegia patients' score increased from (2.2 ± 0.2) scores preoperatively to (3.1± 0.2) scores postoperatively. The height of injured vertebral body, the interangle of vertebral body and spondylolistheses after operation increased comparing with those before operation(P ＜ 0.05 ). No implant loosening or breakage was found. Conclusions Severe spinal cord injury occurs in upper-middle thoracic fracture and dislocation.Unstable fracture should be treated with internal fixation and fusion in time. Decompression ought to be done in patients who suffering from incomplete paraplegia. Early operation takes advantages of immediate stability and a good improvement of the neurologic function.