CAJ | 학술논문

目的探讨后路短节段椎弓根钉固定结合伤椎椎弓根钉固定加伤椎经椎弓根植骨成形术治疗胸腰椎骨折的方法和效果。方法2005年3月至2010年3月治疗组采用传统短节段椎弓根钉固定结合经伤椎椎弓根钉固定和椎体内植骨成形术治疗32例胸腰椎骨折，以同期随机选择的采用传统短节段椎弓根钉固定术治疗的30例胸腰椎骨折为对照组进行临床对比研究，分别测量两组病例术前、术后及末次随访时伤椎椎体前缘高度、脊柱矢状位 Cobb 角，椎管内占位百分比，以 ASIA 2000分级标准评定神经功能；以Charles标准评定临床疗效，并进行统计学分析。结果术后平均随访17.2个月（12～21个月），放射学评估两组患者术后的脊柱重建均较术前有明显改善，两组术后即刻伤椎高度恢复方面疗效相当，但对照组在术后脊柱的后凸矫形和骨折块复位方面较治疗组差（ P＜0.05）。末次随访时治疗组与对照组伤椎椎体前缘高度、脊柱矢状位Cobb角两组比较差异均有统计学意义（ P＜0.05），神经功能和临床疗效评估两组比较差异均无统计学意义，并发症治疗组2例，对照组5例。结论经伤椎椎弓根植骨加伤椎固定结合短节段椎弓根钉固定可提高骨折后凸畸形的矫正度，使脊柱和内固定物的载荷更合理、更稳定，降低了内固定失效和矫形丢失的发生，促进了骨折愈合，是弥补传统短节段椎弓根螺钉内固定手术不足的有效方法。
목적탐토후로단절단추궁근정고정결합상추추궁근정고정가상추경추궁근식골성형술치료흉요추골절적방법화효과。방법2005년3월지2010년3월치료조채용전통단절단추궁근정고정결합경상추추궁근정고정화추체내식골성형술치료32례흉요추골절，이동기수궤선택적채용전통단절단추궁근정고정술치료적30례흉요추골절위대조조진행림상대비연구，분별측량량조병례술전、술후급말차수방시상추추체전연고도、척주시상위 Cobb 각，추관내점위백분비，이 ASIA 2000분급표준평정신경공능；이Charles표준평정림상료효，병진행통계학분석。결과술후평균수방17.2개월（12～21개월），방사학평고량조환자술후적척주중건균교술전유명현개선，량조술후즉각상추고도회복방면료효상당，단대조조재술후척주적후철교형화골절괴복위방면교치료조차（ P＜0.05）。말차수방시치료조여대조조상추추체전연고도、척주시상위Cobb각량조비교차이균유통계학의의（ P＜0.05），신경공능화림상료효평고량조비교차이균무통계학의의，병발증치료조2례，대조조5례。결론경상추추궁근식골가상추고정결합단절단추궁근정고정가제고골절후철기형적교정도，사척주화내고정물적재하경합리、경은정，강저료내고정실효화교형주실적발생，촉진료골절유합，시미보전통단절단추궁근라정내고정수술불족적유효방법。
Objective To disscuss the clinical method and outcome of pedicle screw fixation plus bone graft of vertebral body via pedicle for thoracolumbar fractures .Methods Sixty-two patients treated from 2005 to 2010 were reviewed .Thirty were treated by short segment fixation ( treatment group ) , thirty-two were treated by short-segment pedicle instrumentation combined with trans-pedicular intracorporeal bone grafting and fixation at the level of the fracture(control group).Radiological evaluation was made for measuring Cobb′s angle,the percentage of the anterior and posterior height of injured vertebra and spinal space-occupying rate after operation and during the last follow up.Meanwhile,ASIA 2000 classification standards were used to investigate neurological function and Charles ′standard to evaluate clinical efficacy .Results All the patients achieved fracture union during the last follow-up with a mean period of 17.2 months(range 12-21 months).Radiological evaluation of spinal reconstruction in postoperative were more greatly than preoperative in two groups , but there were same in immediate recover height of injured vertebra.Kyphosis correction and reset fractured vertebra in control group were weaker than treatment group ( P<0.05).At the last follow-up,compared with control group ,Cobb′s angle,the percentage of the anterior and posterior height of injured vertebra and spinal space-occupying rate in treament group were much better .Neural functions showed 1 to 3 grade improvement compared with the findings before operation .There was no difference between two group.The treatment group had 2 cases of complications and the control group had 5 cases.Conclusions Short-segment pedicle instrumentation combined with trans-pedicular intracorporeal bone grafting and fixation at the level of the fracture can correct kyphosis and restore the height of vetebra .Meanwhile,it can make load of spine and internal fixation more reasonable and stable ,and can reduce incidence rate of internal fixation failure and orthopaedic lost .It is an effcient method to make up for the lack of short segment fixation .