CAJ | 학술논문

目的:观察单纯椎弓根钉置入复位固定不行植骨融合对无明显神经损伤的不稳定性胸腰椎爆裂骨折的疗效.方法:回顾性分析解放军第一○一医院骨科收治的行单纯椎弓根钉置入复位内固定而不行植骨融合的无明显神经损伤胸腰段椎体爆裂骨折患者63例,其中40例行AF内固定,16例行Tennor钉棒固定,7例行Diapason钉棒固定.所有患者于椎弓根钉置入前后、及置入后24个月随访时拍正侧位X射线平片以及行损伤椎体及上下相邻椎体的CT检查(其中63例获得了术前、28例术后即刻、以及25例术后24个月时的CT资料).于侧位片测量Cobb角表示成角畸形程度;测量椎体前缘高度丢失表示椎体前部塌陷程度;于CT片上测量椎管正中矢状径表示椎管占位程度;临床疗效采用Greenought等的下腰痛评分法评定.结果:所有患者最后随访时均为24个月,平均住院时间13.4 d,停院至手术平均时间为3.8 d,51例在术后8～12个月取出内固定,取出内固定后住院平均9.4 d.末次随访时根据下腰痛评分标准优46例,良9例,中5例,差3例,优良率88%.Cobb角置入前平均20.1°,置入后平均6.2°,最后随访时11.9°;椎体前缘高度丢失置入前平均49.1%,置入后为17.4%,最后随访时为20.4%;椎管正中矢状径椎弓根钉置入前(n=63)平均49.8%,置入后(n=28)平均78.1%,最后随访时(n=25)平均91.7%;有5例(8%)由于内固定部件断裂致内固定失败;最后随访时影像学参数(Cobb角、椎体前缘高度和椎管正中矢状径)与下腰痛评分无明显相关性.结论:单纯椎弓根钉置入复位固定不行植骨融合对无明显神经损伤的不稳定性胸腰椎爆裂骨折疗效满意,对这种类型骨折治疗常规行后外侧融合是不必要的.
목적:관찰단순추궁근정치입복위고정불행식골융합대무명현신경손상적불은정성흉요추폭렬골절적료효.방법:회고성분석해방군제일○일의원골과수치적행단순추궁근정치입복위내고정이불행식골융합적무명현신경손상흉요단추체폭렬골절환자63례,기중40례행AF내고정,16례행Tennor정봉고정,7례행Diapason정봉고정.소유환자우추궁근정치입전후、급치입후24개월수방시박정측위X사선평편이급행손상추체급상하상린추체적CT검사(기중63례획득료술전、28례술후즉각、이급25례술후24개월시적CT자료).우측위편측량Cobb각표시성각기형정도;측량추체전연고도주실표시추체전부탑함정도;우CT편상측량추관정중시상경표시추관점위정도;림상료효채용Greenought등적하요통평분법평정.결과:소유환자최후수방시균위24개월,평균주원시간13.4 d,정원지수술평균시간위3.8 d,51례재술후8～12개월취출내고정,취출내고정후주원평균9.4 d.말차수방시근거하요통평분표준우46례,량9례,중5례,차3례,우량솔88%.Cobb각치입전평균20.1°,치입후평균6.2°,최후수방시11.9°;추체전연고도주실치입전평균49.1%,치입후위17.4%,최후수방시위20.4%;추관정중시상경추궁근정치입전(n=63)평균49.8%,치입후(n=28)평균78.1%,최후수방시(n=25)평균91.7%;유5례(8%)유우내고정부건단렬치내고정실패;최후수방시영상학삼수(Cobb각、추체전연고도화추관정중시상경)여하요통평분무명현상관성.결론:단순추궁근정치입복위고정불행식골융합대무명현신경손상적불은정성흉요추폭렬골절료효만의,대저충류형골절치료상규행후외측융합시불필요적.
OBJECTIVE:To determine the therapeutic effect of transpedicular instrumentation without fusion on patients with thoracolumbar burst fractures.METHODS:A total of 63 patients with thoracolumbar burst fractures (the inclusion criteria was neurologically intact spine with a kyphotic angle >20° and/or decreased anterior vertebral body height > 50%) who were treated with transpedicular instrumentation without fusion were studied,including 40 cases treated by AF internal fixation,16 cases by Tennor screw-rod fixation system and 7 cases by Diapason screw-rod fixation.All patients underwent a radiological and clinical assessment (including the loss of kyphotic angle,decreased anterior vertebral body height,the midsagital diameter of the canal and the Low Back Outcome Score) preoperatively,postoperatively and after 24 months.The deformity of angulation was measured by Cobb angle.RESULTS:All pstients were followed for a 24 months,with average stay of 13.4 days.There were averaged 3.8 days from admitted to operation,and the internal fixation was removed within 8-12 months in 51 cases,followed a 9.4-day hospital stay.According to low back outcome score,46 patients achieved excellent,9 good,5 fair and 3 poor,with excellent and good rates of 88%.The Cobb's angle was 20.1° preoperatively,6.2° postoperatively,and 11.9° after 24 months.The average lose of anterior vertebral body height was changed from 49.1% preoperatively to 17.4% postoperatively,which was 20.4% after 24 months.The midsagittal diameters was 49.8% (n=63) preoperatively,78.1% (n=28) postoperatively,and 91.7% (n=25) after 24 months.The implant failure occurred in 5 patients.The radiographic parameters had no associativity to the outcome of LBOS.CONCLUSION:Transpedicular instrumentation without fusion is conductive to treating burst fractures of the thoracolumbar spine without nerve injury.The routine posterior or posterolateral fusion is unnecessary in the operative management of these fractures.