CAJ | 학술논문

背景：在胸腰椎骨折中椎弓根螺钉系统近年来已广泛使用，其在恢复患者的伤椎高度及间接椎管减压等方面效果肯定。但因内固定物弯曲、松动或断钉、断棒及由此所致的椎体高度丢失、脊柱后凸畸形亦是临床上常见的问题。 　　目的：回顾性分析采用短节段椎弓根螺钉置入内固定修复胸腰椎严重爆裂骨折的临床效果。 　　方法：回顾性分析江苏省洪泽县人民医院骨科2009年2月至2014年1月收治的51例采用短节段椎弓根螺钉置入内固定修复胸腰椎爆裂骨折患者的临床资料，随访观察内固定前后患者的伤椎高度、后凸 Cbob 角变化以及脊髓神经症状，并记录患者的内固定后并发症情况。 　　结果与结论：51例患者均成功进行内固定治疗，内固定后切口均未出现继发感染，神经功能Frankel分级结果表明脊髓神经症状得到缓解。手术时间45-70 min，平均耗时(60.9±3.7) min；术中患者的出血量为150-700 mL，平均出血量为(330±130) mL。内固定后随访时间均在12个月以上，随访6个月后除2例患者神经功能A级症状无明显改善之外，其余患者均有Ⅰ-Ⅲ级不同程度的恢复。随访12个月腰背疼痛目测类比评分2-5分，动力位X射线片显示固定段无异常活动，同时未发现椎弓钉松动、断裂。提示临床上对胸腰椎严重爆裂性骨折患者采用短节段椎弓根螺钉置入内固定治疗能取得理想的修复效果，是集减压、复位、内固定一次完成的有效方法，能够显著改善患者的生活质量，但同时由于创伤较大，应严格掌握内固定指征。
배경：재흉요추골절중추궁근라정계통근년래이엄범사용，기재회복환자적상추고도급간접추관감압등방면효과긍정。단인내고정물만곡、송동혹단정、단봉급유차소치적추체고도주실、척주후철기형역시림상상상견적문제。 　　목적：회고성분석채용단절단추궁근라정치입내고정수복흉요추엄중폭렬골절적림상효과。 　　방법：회고성분석강소성홍택현인민의원골과2009년2월지2014년1월수치적51례채용단절단추궁근라정치입내고정수복흉요추폭렬골절환자적림상자료，수방관찰내고정전후환자적상추고도、후철 Cbob 각변화이급척수신경증상，병기록환자적내고정후병발증정황。 　　결과여결론：51례환자균성공진행내고정치료，내고정후절구균미출현계발감염，신경공능Frankel분급결과표명척수신경증상득도완해。수술시간45-70 min，평균모시(60.9±3.7) min；술중환자적출혈량위150-700 mL，평균출혈량위(330±130) mL。내고정후수방시간균재12개월이상，수방6개월후제2례환자신경공능A급증상무명현개선지외，기여환자균유Ⅰ-Ⅲ급불동정도적회복。수방12개월요배동통목측류비평분2-5분，동력위X사선편현시고정단무이상활동，동시미발현추궁정송동、단렬。제시림상상대흉요추엄중폭렬성골절환자채용단절단추궁근라정치입내고정치료능취득이상적수복효과，시집감압、복위、내고정일차완성적유효방법，능구현저개선환자적생활질량，단동시유우창상교대，응엄격장악내고정지정。
BACKGROUND:Pedicle screw system has been extensively used in treatment of thoracolumbar fractures. The effects of pedicle screw system in restoring vertebral height in patients and indirect spinal decompression are affirmative. However, fixator bending, loosing or nail breakage, rod breakage and vertebral height loss and kyphosis are common problems in the clinic. OBJECTIVE:To retrospectively analyze the clinical effects of short segmental pedicle internal fixation in the treatment of severe thoracolumbar burst fractures. METHODS:Clinical data of 51 cases of thoracolumbar burst fractures, who were treated with short segmental pedicle internal fixation in Department of Orthopedics of Hongze County People’s Hospital from February 2009 to January 2014, were retrospectively analyzed. Vertebral height, changes in kyphosis Cobb angle and spinal nerve symptoms before and after fixation were observed during fol ow up. Complications after fixation were recorded. RESULTS AND CONCLUSION:A total of 51 patients were successful y treated with internal fixation. After fixation, no secondary infection was observed in the wound. Frankel nerve function grading results showed that spinal nerve symptoms were relieved. Operation time was between 45 and 70 minutes, mean (60.9±3.7) minutes. The amount of intraoperative blood loss was between 150 and 700 mL, mean (330±130) mL. After fixation, fol ow-up time was more than 12 months. After 6 months of fol ow-up, neural function grade A symptom was not obviously improved in two cases. GradesⅠtoⅢwas restored to different degrees in the remaining patients. At 12 months of fol ow-up, low back pain visual analogue scale scores were between 2 and 5. Dynamic radiographs revealed that no abnormal activities were visible in the fixed segment. Simultaneously, no screw loosening or breakage was detected. Results suggested that thoracolumbar burst fractures treated with short segment pedicle screw fixation can achieve ideal clinical curative effect. This is an effective method gathering decompression, reduction and internal fixation completed once, can significantly improve the quality of life of patients, but due to large surgical trauma, we should be strictly grasp the surgical indications.