CAJ | 학술논문

目的：对单节段胸腰椎压缩或爆裂型骨折，在后路钉棒术中，于邻椎椎弓根钉牵引复位基础上，经伤椎椎弓根内置钉，并进行撬拨复位，观察对骨折复位效果。方法：自2006年2月～2010年10月，我们将83例患者分为2组：A组38例，采用后路短节段钉棒牵引复位。 B组45例，采用后路短节段钉棒牵引复位＋经伤椎椎弓根钉撬拨复位。术前、术后1周、术后12个月～15个月，测量侧位X片上伤椎Cobb角、前缘高度（前高）。分别计算伤椎前高压缩比，伤椎Cobb氏角丢失比；测量术前、复位固定后CT片上伤椎椎管中矢径，计算椎管侵占率。对所测数值进行比较分析，评估效果。结果：2组椎体前高压缩比、伤椎Cobb氏角丢失比、椎管平均侵占率术前比较差异无显著（P＞0．5），术后1周、12个月后比较差异显著性（P＜0．5）。结论：单节段胸腰椎压缩或爆裂型骨折，伤椎置入椎弓根钉，并对骨折进行撬拨复位，能更好的矫正伤椎前缘塌陷，使侵占椎管骨折块退出椎管，加强固定强度，提高了后路钉棒术对骨折的复位疗效。
목적：대단절단흉요추압축혹폭렬형골절，재후로정봉술중，우린추추궁근정견인복위기출상，경상추추궁근내치정，병진행효발복위，관찰대골절복위효과。방법：자2006년2월～2010년10월，아문장83례환자분위2조：A조38례，채용후로단절단정봉견인복위。 B조45례，채용후로단절단정봉견인복위＋경상추추궁근정효발복위。술전、술후1주、술후12개월～15개월，측량측위X편상상추Cobb각、전연고도（전고）。분별계산상추전고압축비，상추Cobb씨각주실비；측량술전、복위고정후CT편상상추추관중시경，계산추관침점솔。대소측수치진행비교분석，평고효과。결과：2조추체전고압축비、상추Cobb씨각주실비、추관평균침점솔술전비교차이무현저（P＞0．5），술후1주、12개월후비교차이현저성（P＜0．5）。결론：단절단흉요추압축혹폭렬형골절，상추치입추궁근정，병대골절진행효발복위，능경호적교정상추전연탑함，사침점추관골절괴퇴출추관，가강고정강도，제고료후로정봉술대골절적복위료효。
Objective:Using the method of localization needle navigation , our aim is to study the effect of the posterior pedicle screw and rod fixation system in the treatment of single -level thoracolumbar spinal fractures in prone position on a specially manufactured spi -nal brace , by applying such surgical techniques as placing screw through multifidus space , fractured vertebral transpedicular screw , po-king reduction and so on ( called minimally invasive ) .Methods:From February 2006 to October 2010 , 61 patients with single-level tho-racolumbar spinal fractures underwent minimally invasive surgery .The post-operative follow-up was between 12 and 15 months.The blood loss , surgical wounds , complications , the reduction and fixation performance of fractured vertebrae were evaluated and analyzed , retrospectively .Results:The reliable clinical outcome demonstrated less surgical wounds , less blood loss and no iatrogenic spinal cord in-jury (ISCI).In addition, the anterior high compression ratio of fractured vertebrae was 42.5%, 3.3%and 5.5%, before, after and one year after surgery, respectively.The adjacent vertebral average Cobb angle loss ratio turned from 43.3% to 3.4% after operation and then to 6.5%after one year.The average spinal canal encroachment ratio became 14.5%after reduction and fixation from the pre -op-erative 46.2%.Conclusion:The minimally invasive surgery is an effective approach in the treatment of single -level thoracolumbar frac-tures, with the advantages of alleviating surgical wounds , decreasing complication rates and improving safety .Moreover, it possesses reli-able and direct reduction strength and excellent fixation performance , brings better kyphosis correction and force fractures causing com-pression out of spinal canal .