CAJ | 학술논문

目的评价小切口腹膜外入路手术治疗下腰椎爆裂性骨折的疗效,并探讨手术技巧.方法回顾性分析小切口腹膜外入路手术治疗的21例严重下腰椎爆裂性骨折病例.男15例,女6例;年龄19～65岁,平均35.9岁.L3 10例,L4 8例,L5 3例.按照Magerl分型(AO分型)：A类(爆裂型)12例,B类(分离型)2例,C类(扭转型)7例.所有病例均行小切口腹膜外入路伤椎部分切除减压、植骨融合及内固定.分别比较术前与术后即刻的影像学指标变化,及术前与术后末次随访时神经功能(ASIA分级)的变化.结果术后平均随访41.9个月(12～86个月).术后即刻影像学资料显示：伤椎椎体前缘高度由术前平均42.62％±10.32％恢复至94.33％±5.23％(P＜0.01),椎管受堵指数由术前平均2.67±0.86恢复至0.14±0.36(P＜0.01).除1例L3、T11骨折并完全截瘫者外,余有神经损伤者在术后末次随访时均出现一级以上的恢复.随访期间内固定无松动、断裂等发生.结论对于严重下腰椎爆裂性骨折,采用小切口腹膜外入路进行减压和固定,具有创伤小、神经功能恢复良好的效果.
목적 평개소절구복막외입로수술치료하요추폭렬성골절적료효,병탐토수술기교.방법 회고성분석소절구복막외입로수술치료적21례엄중하요추폭렬성골절병례.남15례,녀6례;년령19～65세,평균35.9세.L3 10례,L4 8례,L5 3례.안조Magerl분형(AO분형)：A류(폭렬형)12례,B류(분리형)2례,C류(뉴전형)7례.소유병례균행소절구복막외입로상추부분절제감압、식골융합급내고정.분별비교술전여술후즉각적영상학지표변화,급술전여술후말차수방시신경공능(ASIA분급)적변화.결과 술후평균수방41.9개월(12～86개월).술후즉각영상학자료현시：상추추체전연고도유술전평균42.62％±10.32％회복지94.33％±5.23％(P＜0.01),추관수도지수유술전평균2.67±0.86회복지0.14±0.36(P＜0.01).제1례L3、T11골절병완전절탄자외,여유신경손상자재술후말차수방시균출현일급이상적회복.수방기간내고정무송동、단렬등발생.결론 대우엄중하요추폭렬성골절,채용소절구복막외입로진행감압화고정,구유창상소、신경공능회복량호적효과.
Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years (ranged, 19-65 years). The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A (burst in 12 cases, type B (distraction) in 2 and type C (retortion) in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months (12-86 months). The radiograph showed obvious improvement on the injured body height (from 42.62％ preoperatively to 94.33％ postoperatively, P＜0.01) and the canal encroachment index (from 2.67 preoperatively to 0.14 postoperatively, P＜0.01). Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures.