CAJ | 학술논문

目的探讨后路单节段经伤椎固定治疗脊柱胸腰段不完全爆裂骨折的可行性、安全性和疗效.方法回顾分析2005年4月至2010年1月脊柱胸腰段不完全爆裂骨折资料共56例,其中单节段固定组28例,短节段固定组28例.比较两组患者手术时间,出血量,术前、术后视觉模拟量表(VAS)评分和伤椎后凸角等.结果单节段固定组手术平均时间(93±20)min;平均术中出血量(184±64)ml;伤椎后凸角术前17°±10°,术后1周7°±7°,末次随访时10°±7°;VAS评分术前7.6±1.5,术后1周2.4±0.8,末次随访1.5±0.9;术后未发现相邻节段退变征象.短节段固定组手术平均时间(102±30)min;平均术中出血量(203±88)ml;伤椎后凸角术前17°±9°,术后1周7°±7°,末次随访8°±5°;VAS评分术前6.8±1.3,术后1周3.1±0.5,末次随访1.2±0.7;1例患者术后36个月随访时出现固定相邻节段的退变.两组间手术时间,出血量,术前、术后1周及末次随访时伤椎后凸角和VAS评分相比差异均无统计学意义(P＞0.05).两组术后1周及末次随访时VAS评分较术前均有明显改善,伤椎后凸角度术后1周及末次随访时较术前明显减小,差异均有统计学意义(P＜0.05).结论单节段经伤椎固定治疗脊柱胸腰段不完全爆裂骨折安全、有效,但在术中出血量、手术时间、术后VAS评分改善和伤椎后凸角恢复方面与短节段固定组无显著差异.
목적 탐토후로단절단경상추고정치료척주흉요단불완전폭렬골절적가행성、안전성화료효.방법 회고분석2005년4월지2010년1월척주흉요단불완전폭렬골절자료공56례,기중단절단고정조28례,단절단고정조28례.비교량조환자수술시간,출혈량,술전、술후시각모의량표(VAS)평분화상추후철각등.결과 단절단고정조수술평균시간(93±20)min;평균술중출혈량(184±64)ml;상추후철각술전17°±10°,술후1주7°±7°,말차수방시10°±7°;VAS평분술전7.6±1.5,술후1주2.4±0.8,말차수방1.5±0.9;술후미발현상린절단퇴변정상.단절단고정조수술평균시간(102±30)min;평균술중출혈량(203±88)ml;상추후철각술전17°±9°,술후1주7°±7°,말차수방8°±5°;VAS평분술전6.8±1.3,술후1주3.1±0.5,말차수방1.2±0.7;1례환자술후36개월수방시출현고정상린절단적퇴변.량조간수술시간,출혈량,술전、술후1주급말차수방시상추후철각화VAS평분상비차이균무통계학의의(P＞0.05).량조술후1주급말차수방시VAS평분교술전균유명현개선,상추후철각도술후1주급말차수방시교술전명현감소,차이균유통계학의의(P＜0.05).결론 단절단경상추고정치료척주흉요단불완전폭렬골절안전、유효,단재술중출혈량、수술시간、술후VAS평분개선화상추후철각회복방면여단절단고정조무현저차이.
Objective To investigate the safety and therapeutic effects of monosegment pedicle instrumentation in treating incomplete thoracolumbar burst fracture. Methods A retrospective analysis was conducted on 56 inpatients with incomplete thoracolumbar burst fracture ( AO classification: A3. 1 and A3.2) from April 2005 to January 2010. There were 28 cases were fixed with monosegment pedicle instrumentation (MSPI), 28 cases were fixed with short segment pedicle instrumentation (SSPI). The operative time, blood loss, visual analogue scale(VAS) and vertebral kyphotic angle(VK) before and after surgery were evaluated. Results In the group of MSPI, the mean operative time was (93 ± 20) min; the intraoperative blood loss was (184 ±64) ml; the VK angle was 17°± 10° before operation, 7°±7° at one week after operation, and 10°±7° at latest follow-up; VAS score was 7. 6 ± 1.5 before operation, 2. 4 ±0. 8at one week after operation, and 1.5 ± 0. 9 at latest follow-up; no adjacent segment degeneration was found. In the group of SSPI, the operative time was ( 102 ±30) min; the intraoperative blood loss was (203±88) ml; the VK angle was 17°±9° before operation, 7°±7° at one week after operation, and 8°±5° at latest follow-up; VAS score was 6. 8 ± 1.3 before operation, 3. 1 ± 0. 5 at one week after operation, and 1.2 ±0. 7 at latest follow-up. One case of adjacent segment degeneration was found in 36 months after operation. There were no significantly statistical differences between two groups in operative time, blood loss,VAS score and VK angle before and after surgery ( P ＞ 0. 05 ). The VAS score and VK angle at one week after surgery and latest follow-up all decreased obviously than preoperative ones in both groups( P ＜0. 05 ).Conclusions MSPI for incomplete thoracolumbar burst fracture is effective and safe. The operative blood loss, the mean operative time, the improvement of VAS score and the VK angle in group MSPI are equal to those in group SSPI.