CAJ | 학술논문

目的对比跨伤椎固定与经伤椎固定治疗胸腰段脊柱骨折的疗效. 方法回顾性分析2005年6月-2008年12月分别采用跨伤椎固定与经伤椎固定治疗的56例胸腰段脊柱骨折,其中男41例,女15例；年龄21 ～ 66岁,平均41.5岁.损伤部位:T1213例,L127例,L2 16例.按AO分型:A1.2型6例,A3.1型29例,A3.2型9例,A3.3型12例.载荷评分5～8分,平均6.3分.脊髓神经损伤按Frankel分级:A级3例,B级4例,C级8例,D级17例,E级24例.采用椎弓根螺钉跨伤椎固定27例,经伤椎固定29例,两组患者均选择性进行单节段植骨融合.对比两组患者术前、术后和最后随访时的Cobb角、伤椎前缘高度恢复及椎管占位情况的变化.随访过程中观察植骨融合和脊髓神经恢复情况.采用Denis评分比较两组患者局部疼痛和工作状态的恢复差异. 结果所有患者获随访12 ～48个月,平均25.8个月.跨伤椎固定组1例于术后1.5个月出现棒松动,其余未出现内固定松动或断裂现象.在术后Cobb角矫正、椎体前缘高度恢复、椎管占位率恢复及最后随访时椎体前缘高度和椎管占位保持方面两组间差异无统计学意义(P＞0.05).术后两组患者矫正度均存在丢失现象,跨伤椎固定组最后随访时的Cobb角与术后比较差异有统计学意义(P＜0.05),经伤椎固定组最后随访时的Cobb角与术后比较差异无统计学意义(P＞0.05),两组间Cobb角矫正度丢失率差异有统计学意义(P＜0.05).跨伤椎固定组植骨融合21例(78％),经伤椎固定组植骨融合27例(93％)(P＜0.05).在局部疼痛评分上,经伤椎固定组优于跨伤椎固定组(P＜0.05),而在工作状态的恢复方面两组差异无统计学意义(P＞0.05).结论相对跨伤椎固定,经伤椎固定治疗胸腰椎骨折能够获得较高的植骨融合率,同时能更好地维持脊柱矫正度,是胸腰椎骨折后路治疗的较好选择.
목적 대비과상추고정여경상추고정치료흉요단척주골절적료효. 방법 회고성분석2005년6월-2008년12월분별채용과상추고정여경상추고정치료적56례흉요단척주골절,기중남41례,녀15례；년령21 ～ 66세,평균41.5세.손상부위:T1213례,L127례,L2 16례.안AO분형:A1.2형6례,A3.1형29례,A3.2형9례,A3.3형12례.재하평분5～8분,평균6.3분.척수신경손상안Frankel분급:A급3례,B급4례,C급8례,D급17례,E급24례.채용추궁근라정과상추고정27례,경상추고정29례,량조환자균선택성진행단절단식골융합.대비량조환자술전、술후화최후수방시적Cobb각、상추전연고도회복급추관점위정황적변화.수방과정중관찰식골융합화척수신경회복정황.채용Denis평분비교량조환자국부동통화공작상태적회복차이. 결과 소유환자획수방12 ～48개월,평균25.8개월.과상추고정조1례우술후1.5개월출현봉송동,기여미출현내고정송동혹단렬현상.재술후Cobb각교정、추체전연고도회복、추관점위솔회복급최후수방시추체전연고도화추관점위보지방면량조간차이무통계학의의(P＞0.05).술후량조환자교정도균존재주실현상,과상추고정조최후수방시적Cobb각여술후비교차이유통계학의의(P＜0.05),경상추고정조최후수방시적Cobb각여술후비교차이무통계학의의(P＞0.05),량조간Cobb각교정도주실솔차이유통계학의의(P＜0.05).과상추고정조식골융합21례(78％),경상추고정조식골융합27례(93％)(P＜0.05).재국부동통평분상,경상추고정조우우과상추고정조(P＜0.05),이재공작상태적회복방면량조차이무통계학의의(P＞0.05).결론 상대과상추고정,경상추고정치료흉요추골절능구획득교고적식골융합솔,동시능경호지유지척주교정도,시흉요추골절후로치료적교호선택.
Objective To compare the clinical results of pedicle screw fixation via the injured vertebra versus across the injured vertebra for thoracolumbar spine fracture. Methods The study reviewed 56 patients (41 males and 15 females,at age range of 21-66 years,mean 41.5 years) with thoracolumbar spine fractures managed with the two fixation methods from June 2005 to December 2008.The fracture segment included T12 in 13 patients,L1 in 27 and L2 in 16.According to the AO classification,there were six patients with type A1.2,29 with type A3.1,nine with type A3.2 and 12 with type A3.3.McCormack load score was 5-8 points (average 6.3 points). The spinal cord injury was classified as grade A in three patients,grade B in four,grade C in eight,grade D in 17 and grade E in 24 according to Frankel scale.The patients were divided into two groups,ie,across vertebral fixation group (27 patients) and via the vertebral fixation group (29 patients).All patients were selectively treated with monosegment bone graft simultaneously.The Cobb' s angle,restoration of the anterior height of the injured vertebra,improvement of spinal canal stenosis rate and Denis scale in local pain and work status were compared between the two groups.The bone graft fusion and spinal cord recovery of both groups were observed during follow-up. Results All patients were followed up for 12-48 months (average 25.8 months).Implantation loosening occurred in one patient 1.5 month after operation in across vertebral fixation group.There were no significant differences in aspects of correction of Cobb' s angle,restoration of the anteriorheight of injured vertebra and improvement of spinal canal stenosis rate postoperatively as well as in aspects of restoration of anterior height of injured vertebra and improvement of spinal canal stenosis rate at the latest follow-up between the two groups ( P ＞ 0.05).The postoperative loss of correction rate of Cobb's angle of both groups existed,with significant difference (P ＜0.05). The differences of the Cobb's angle at the latest follow-up and after operation were significant in the across vertebral fixation group ( P ＜ 0.05) but insignificant in the via vertebral fixation group (P ＞ 0.05 ).Bone graft fusion occurred in 21 patients (78％) in the across vertebral fixation group and in 27 patients (93％) in the via vertebral fixation group ( P ＜ 0.05 ).Denis scale indicated a better recovery in the local pain of via vertebral fixation group compared with the across vertebral fixation group ( P ＜ 0.05 ),but showed no significant differenc e in work status between the two groups ( P ＞ 0.05 ). Conclusions Compared with across vertebral fixation,the pedicle screw fixation via the vertebra has the advantages of higher fusion rate and better correction rate of Cobb' s angle and is a better choice for thoracolumbar spine fracture with posterior approach.