CAJ | 학술논문

目的探讨经单一后路椎体次全切除、椎弓根钉固定结合前中柱钛网植骨一期三柱重建治疗严重胸腰椎骨折的临床效果.方法采用经后路椎体次全切除、椎弓根钉固定结合前中柱钛网植骨重建治疗严重胸腰椎骨折患者44例,男35例,女9例;年龄19～66岁,平均37.3岁;T11 1例,T12 5例,L1 20例,L2 11例,L3 5例,L4 2例.骨折按AO分型:A3型24例,B1和B2型共17例,C1型3例.神经功能ASIA分级:A级10例,B级17例,C级10例,D级7例.通过对术前、术后即刻、术后2年时神经功能和矫形效果的比较分析临床疗效,总结早期并发症并分析其原因.结果 44例患者获得随访,随访时间24～58个月,平均38.9个月.术后2年随访时,除1例术前ASIA分级为A级的患者损伤未恢复外,其余43例神经功能均有ASIA分级1～2级的恢复.术后影像学检查显示减压和复位效果满意.43例(97.7%)于末次随访时未见内固定松动征象,矫正度维持良好.并发症包括:术中大出血(＞1500 ml)9例,一过性神经根损伤4例,脑脊液漏3例,固定松动钛网塌陷、矫正度严重丢失1例,钛网位置不良3例,医原性游离骨块遗留椎管内2例,浅层感染1例.结论经后路椎体次全切除及重建治疗严重胸腰椎骨折的方法具有减压充分,融合效果良好的优点,是一种较好的替代前、后路联合手术的术式.
목적 탐토경단일후로추체차전절제、추궁근정고정결합전중주태망식골일기삼주중건치료엄중흉요추골절적림상효과.방법 채용경후로추체차전절제、추궁근정고정결합전중주태망식골중건치료엄중흉요추골절환자44례,남35례,녀9례;년령19～66세,평균37.3세;T11 1례,T12 5례,L1 20례,L2 11례,L3 5례,L4 2례.골절안AO분형:A3형24례,B1화B2형공17례,C1형3례.신경공능ASIA분급:A급10례,B급17례,C급10례,D급7례.통과대술전、술후즉각、술후2년시신경공능화교형효과적비교분석림상료효,총결조기병발증병분석기원인.결과 44례환자획득수방,수방시간24～58개월,평균38.9개월.술후2년수방시,제1례술전ASIA분급위A급적환자손상미회복외,기여43례신경공능균유ASIA분급1～2급적회복.술후영상학검사현시감압화복위효과만의.43례(97.7%)우말차수방시미견내고정송동정상,교정도유지량호.병발증포괄:술중대출혈(＞1500 ml)9례,일과성신경근손상4례,뇌척액루3례,고정송동태망탑함、교정도엄중주실1례,태망위치불량3례,의원성유리골괴유류추관내2례,천층감염1례.결론 경후로추체차전절제급중건치료엄중흉요추골절적방법구유감압충분,융합효과량호적우점,시일충교호적체대전、후로연합수술적술식.
Objective To analyze the clinical results and early complications of corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior approach for severe thoracic and lumbar fractures.Methods Forty-four patients treated by reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior were studied retrospectively.There were 35 males and 9 females,with an average age of 37.3 years(range,19-66 years).The injury segments include 1 case at T11,5 cases at T12,20 cases at L1,11 cases at L2,5 cases at L3 and 2 cases at L4.According to AO classification,there were 24 cases of A3,17 cases of B1 and B2,and 3 cases of C1.According to ASIA,there were 10 cases of grade A,17 cases of grade B,10 cases of grade C and 7 cases of grade D.The neurologic function and effectiveness of correction of preoperative,immediate postoperative and 2years follow-up were compared,and the clinical outcome and early complications were analyzed.Results The follow-up time was 24 to 58 months,mean 38.9 months.At the time of 2 years postoperation,43 cases of incomplete neurologic deficit had improved 1 or 2 ASIA grades except 1 case of grade A.The results of decompression and reduction were satisfactory from the postoperative radiographic examinations.The correction maintained well and the implant loosening was not seen in 43 cases(97.7%)at the last follow-up.The com plications include:excessive blood loss(＞1500 ml)in 9 cases,transient nerve root injury in 4,cerebrospinal fluid leakage in 3,instrumentation failure in 1,mesh cage malposition in 3,iatrogenic leaving of free bone granula into the canal in 2,and superficial infection in 1.Conclusion This technique is effective for decompression and fusion,less invasive than combined anteroposterior procedure,and may be another good alternative for the treatment of severe thoracic and lumbar fractures.The early complications are not rare,but most of them are not serious and are relative to techniques.