CAJ | 학술논문

背景：目前已有多项研究报道了短节段非融合内固定修复胸腰椎爆裂骨折的早期临床效果，结果令人鼓舞，但该方案治疗胸腰椎爆裂骨折的中远期随访结果尚少见报道。 　　目的：评价非融合短节段椎弓根螺钉置入内固定修复不稳定胸腰椎爆裂骨折的中期临床效果。 　　方法：回顾分析因不稳定性胸腰椎爆裂骨折接受短节段椎弓根螺钉置入内固定非融合治疗的12例患者资料。所有患者均存在严重的椎管内占位并伴有神经功能障碍，且均为胸腰椎单节段损伤，内固定前实施体位复位2 d后在伤椎及其上、下节段水平进行椎弓根螺钉内固定，内固定后12个月取出内固定物。临床以及影像学评价指标包括椎管内占位情况、椎体高度丢失率、Cobb角、美国脊柱损伤学会(ASIA)运动神经评分、Frankel分级以及损伤相邻节段退变情况等。 　　结果与结论：所有患者均获至少5年的随访。在椎管内占位率、椎体高度丢失率以及Cobb角评估方面，内固定后多次测量结果较之初次内固定前，差异均有显著性意义(P<0.05)，内固定后多次评估结果均显著优于内固定前，但内固定后多次评估结果之间差异无显著性意义(P>0.05)。内固定置入后及其取出后，所有病例均未出现神经功能损害症状加重。患者内固定前的ASIA运动神经评分为34.2±6.3，末次随访时为47.7±9.5，差异有显著性意义(t=-4.103，P=0.000)。在末次随访时，所有患者的损伤水平相邻节段均未发生退变，神经功能获得Frankel分级1或2级的恢复。提示伴有神经损害症状的不稳定胸腰椎爆裂骨折患者，采用非融合短节段椎弓根螺钉内固定治疗中期效果良好，可有效重建和维持脊柱的矢状位对线，且不会导致损伤水平相邻节段退变的发生。
배경：목전이유다항연구보도료단절단비융합내고정수복흉요추폭렬골절적조기림상효과，결과령인고무，단해방안치료흉요추폭렬골절적중원기수방결과상소견보도。 　　목적：평개비융합단절단추궁근라정치입내고정수복불은정흉요추폭렬골절적중기림상효과。 　　방법：회고분석인불은정성흉요추폭렬골절접수단절단추궁근라정치입내고정비융합치료적12례환자자료。소유환자균존재엄중적추관내점위병반유신경공능장애，차균위흉요추단절단손상，내고정전실시체위복위2 d후재상추급기상、하절단수평진행추궁근라정내고정，내고정후12개월취출내고정물。림상이급영상학평개지표포괄추관내점위정황、추체고도주실솔、Cobb각、미국척주손상학회(ASIA)운동신경평분、Frankel분급이급손상상린절단퇴변정황등。 　　결과여결론：소유환자균획지소5년적수방。재추관내점위솔、추체고도주실솔이급Cobb각평고방면，내고정후다차측량결과교지초차내고정전，차이균유현저성의의(P<0.05)，내고정후다차평고결과균현저우우내고정전，단내고정후다차평고결과지간차이무현저성의의(P>0.05)。내고정치입후급기취출후，소유병례균미출현신경공능손해증상가중。환자내고정전적ASIA운동신경평분위34.2±6.3，말차수방시위47.7±9.5，차이유현저성의의(t=-4.103，P=0.000)。재말차수방시，소유환자적손상수평상린절단균미발생퇴변，신경공능획득Frankel분급1혹2급적회복。제시반유신경손해증상적불은정흉요추폭렬골절환자，채용비융합단절단추궁근라정내고정치료중기효과량호，가유효중건화유지척주적시상위대선，차불회도치손상수평상린절단퇴변적발생。
BACKGROUND:Many present studies have reported the early clinical therapeutic effects of short-segment non-fusion fixation for the repair of thoracolumbar burst fracture. The results are satisfactory. However, the mid-and long-term fol ow-up results of this scheme for treating thoracolumbar burst fracture are seldom reported. OBJECTIVE:To evaluate the mid-term results of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture. METHODS:Data of 12 patients with unstable thoracolumbar burst fractures undergoing short segment pedicle screw fixation without bone fusion were retrospectively analyzed. Al patients experienced severe intraspinal occupying and neurological dysfunction, and al of them affected single segment thoracolumbar injuries. The surgical procedure included postural reduction for 2 days and screw fixations at one level above, one level below and at the fractured level itself. The patients underwent removal of implants at 12 months after the initial operation. Imaging and clinical findings, including canal encroachment, percentage of vertebral body height loss, Cobb angle, American Spinal Injury Association motor score, Frankel grade and adjacent segment degenemtion, were evaluated. RESULTS AND CONCLUSION:Al patients were fol owed up for at least 5 years. Significant differences in canal encroachment, percentage of vertebral body height loss and Cobb angle were detectable between post-fixation and pre-fixation (P<0.05). Evaluation results were significantly better after fixation than that before fixation, but no significant difference in evaluation results after fixation was detected (P>0.05). After implantation and removal of fixator, none cases affected aggravated symptoms of neurological impairment. American Spinal Injury Association motor score was 34.2±6.3 before fixation, and 47.7±9.5 during the final fol ow-up, showing significant differences (t=-4.103, P=0.000). During the final fol ow-up, adjacent segments in damage levels did not suffer from degeneration in al patients. Neurological function showed the recovery of Frankel grades 1 or 2. These data indicated that a good mid-term result of short segment pedicle screw fixation without bone fusion for unstable thoracolumbar burst fracture with neurological deficit can be achieved. The improved saggital alignment was effectively constructed and maintained. Adjacent segment degeneration was not found at the injury level.