CAJ | 학술논문

目的探讨强直性脊柱炎(AS)胸腰椎骨折手术方法的选择.方法对1997年6月至2010年1月收治的17例AS胸腰椎骨折患者资料进行回顾性研究,男16例,女l例;年龄32 ～61岁,平均47.8岁.依据AS胸腰椎骨折的损伤机制、影像学特征,将其分为椎体型(VB型)和椎间隙型(IS 型).其中VB型骨折6例,采用经椎弓根椎体楔形截骨、后路内固定术;IS型骨折11例,采用前路椎管减压支撑植骨、前后联合内固定术.结果所有患者均在术中获得骨折断面的有效接触,并解除脊髓压迫、改善胸腰椎矢状面平衡.所有患者术后获1.5 ～4.O年(平均26个月)随访;骨折愈合时间为16 ～ 20周,平均18.0周.未发生内固定松动或断裂、骨折不愈合及神经性和感染性的并发症.末次随访时多数患者神经功能Frankel分级有所改善.所有患者术后腰背疼痛立即得到缓解;术前cobb角平均为48.0°±8.5°,术后即刻为30.4°±1.3°,末次随访时为30.9°±1.3°,术后即刻与末次随访时较术前均明显改善,差异均有统计学意义(F=2525.147,P=0.000),而术后即刻与末次随访时比较差异无统计学意义(P≥0.05).结论依据AS胸腰椎骨折的类型与损伤机制选择手术方式,能增强骨折断面间的稳定性,有效恢复椎管容积及脊柱的应力轴线,减少脊髓损伤并发症.
목적 탐토강직성척주염(AS)흉요추골절수술방법적선택.방법 대1997년6월지2010년1월수치적17례AS흉요추골절환자자료진행회고성연구,남16례,녀l례;년령32 ～61세,평균47.8세.의거AS흉요추골절적손상궤제、영상학특정,장기분위추체형(VB형)화추간극형(IS 형).기중VB형골절6례,채용경추궁근추체설형절골、후로내고정술;IS형골절11례,채용전로추관감압지탱식골、전후연합내고정술.결과 소유환자균재술중획득골절단면적유효접촉,병해제척수압박、개선흉요추시상면평형.소유환자술후획1.5 ～4.O년(평균26개월)수방;골절유합시간위16 ～ 20주,평균18.0주.미발생내고정송동혹단렬、골절불유합급신경성화감염성적병발증.말차수방시다수환자신경공능Frankel분급유소개선.소유환자술후요배동통립즉득도완해;술전cobb각평균위48.0°±8.5°,술후즉각위30.4°±1.3°,말차수방시위30.9°±1.3°,술후즉각여말차수방시교술전균명현개선,차이균유통계학의의(F=2525.147,P=0.000),이술후즉각여말차수방시비교차이무통계학의의(P≥0.05).결론 의거AS흉요추골절적류형여손상궤제선택수술방식,능증강골절단면간적은정성,유효회복추관용적급척주적응력축선,감소척수손상병발증.
Objective To cxplore the operative strategies for thoracicolumbar fractures in ankylosing spondylitis. Methods From June 1997 to January 2010,17 cases of thoracolumbar fracture in ankylosing spondylitis were operated on in our department.They were 16 men and one woman,aged from 32 to 61 years (average,47.8 years).The thoracolumbar fractures were in the vertebral body (VB type) and the intervertebral space (IS type) based on the injury mechanisms and radiographic manisfestations.Six cases of VB type underwent wedge osteotomy via the vertebral pedicle and posterior internal fixation,and 11 cases of IS type underwent anterior decompression of the spinal canal and strut bone graft fusion followed by anterior-posterior internal fixation. Results All cases gained effective bone contact between the fracture ends,relieved spinal compression and improved balance of the thoracolumbar spine in sagittal plane during the operation.All the patients were followed for 1.5 to 4.0 years after operation (average,26 months).The fracture healded at an average of 18.0 weeks (range,from 16 to 20 weeks).No implant loosening or rupture,nonunion signs,neurologic or infectious complications were observed.At the final follow-up,the Frankle grading for neurologic function was improved in most patiens.Mter surgery,low back pain was relieved immediately in all patients.The average cobb's angle was 48.0° ± 8.5° preoperation,30.4° ± 1.3° postoperation and 30.9° ± 1.3° at the final follow-up.There was a significant difference between preoperation and postoperation ( F =2525.147,P =0.000),but no significant difference between postoperation and the final follow-up ( P ≥ 0.05).Conclusions Operative strategies should be based on the type and injury biomechanism of the thoracolumbar fracture in ankylosing spondylitis. An appropriate strategy can lead to increased stability of fracture ends,effective restoration of canal volume and stress axis of the spine and decreased complications associated with the spinal cord injury.