CAJ | 학술논문

目的探讨前路减压加后路硬膜内松解治疗陈旧性胸腰段骨折伴不全瘫的效果.方法对2004年1月-2008年1月收入我院的22例陈旧性胸腰段骨折伴不全瘫患者采用前路减压加后路硬膜内松解术,该22例患者均已在外院行后路减压椎弓根系统内固定术,术后神经功能较术前恢复不明显,且CT证实椎管内仍有骨性压迫,MRI显示脊髓连续性仍存在.除2例患者改为前路减压Z-plate固定外,其余20例均保留原椎弓根系统,仅植入自体髂骨.术后3～6个月Ⅱ期行后路硬膜内显微松解术. 结果 19例获随访,随访时间17～49个月(平均28个月).减压术后22例中20例有不同程度的神经功能改善,ASIA运动评分由术前的平均59.4分提高到术后的平均71.3分.Ⅱ期后路硬膜内松解后,获随访的19例患者均有不同程度的改善,ASIA评分最后提高到平均80.6分. 结论对于陈旧性胸腰段骨折伴不全瘫患者,除了前路骨性压迫的减压外,硬膜内瘢痕及纤维束带压迫的松解也是非常重要的.
목적 탐토전로감압가후로경막내송해치료진구성흉요단골절반불전탄적효과.방법 대2004년1월-2008년1월수입아원적22례진구성흉요단골절반불전탄환자채용전로감압가후로경막내송해술,해22례환자균이재외원행후로감압추궁근계통내고정술,술후신경공능교술전회복불명현,차CT증실추관내잉유골성압박,MRI현시척수련속성잉존재.제2례환자개위전로감압Z-plate고정외,기여20례균보류원추궁근계통,부식입자체가골.술후3～6개월Ⅱ기행후로경막내현미송해술. 결과 19례획수방,수방시간17～49개월(평균28개월).감압술후22례중20례유불동정도적신경공능개선,ASIA운동평분유술전적평균59.4분제고도술후적평균71.3분.Ⅱ기후로경막내송해후,획수방적19례환자균유불동정도적개선,ASIA평분최후제고도평균80.6분. 결론대우진구성흉요단골절반불전탄환자,제료전로골성압박적감압외,경막내반흔급섬유속대압박적송해야시비상중요적.
Objective To explore the effect of anterior decompression plus posterior intradural release in treatment of old thoracolumbar fractures with paraparesis. Methods A total of 22 patients with old thoracolumbar fractures with paraparesis were admitted to our hospital since January 2004 to Jan-uary 2008. Before admission, all patients were treated with decompression and internal fixation with pos-terior pedicle system, with bony compression to the spinal cord found through CT scanning and intact spi-nal cord found by MRI but without obvious neurofunction recovery. Of all, 20 patients were kept with the original posterior fixation except for two patients that were fixed with Z-plate after removal of posterior hardware. Autologous bone grafts from iliac were utilized in all patients. Intradural release was done 3-6 months after anterior decompression. Results Of all, 19 patients were followed up for 17-49 months (average 28 months). Twenty patients obtained varied recovery of neurofunction after anterior decompres-sion, with ASIA motor scores increasing from average 59.4 points before decompression to 71.3 after de-compression. The followed-up patients won further recovery after secondary posterior intradural release, with ASIA motor scores further increasing to average 80.6 points. Conclusion For patients with old thoracolumbar fractures combined with paraparesis, the release of intradural sear and fibrocompression is also important besides anterior decompression.