CAJ | 학술논문

目的：探讨后路固定角度侧块、椎弓根钉棒系统治疗无神经损伤胸腰椎骨折的治疗效果。方法2008年10月至2012年2月，38例无神经系统症状的机械不稳定胸腰段爆裂骨折且无需减压的患者，采用后路固定角度侧块(-100、-50、00、50、100)、椎弓根钉棒系统经椎弓根复位固定：无后方韧带复合体损伤者给予单纯短节段固定，有后方韧带复合体损伤但伤椎椎弓根完整者给予伤椎椎弓根螺丝钉固定，合并伤椎椎弓根损伤者给予上下两个椎体固定，所有后方韧带复合体损伤者均后外侧植骨融合。所有病例术后1～3天戴支具下地活动。所有病例均行术前、术后 X 线片及 CT、MRI 扫描。结果32例获得了完整的随访，随访时间4～40个月，平均28.2个月，无断钉、断棒、内固定失效；平均手术时间92(82.6±19.2) min；术后伤椎高度由术前平均41.6%，恢复到术后平均91.2%；后凸Cobb’s角由术前平均35.3°，恢复到术后平均7.8°；矢状面位移由术前平均(32.7±7.6)％，恢复到术后(8.7±4.9)％( P＜0.05)。结论固定角度侧块、椎弓根钉棒系统是治疗无神经损伤机械不稳定胸腰段爆裂骨折的一种有效方法，该固定系统具有结构简单，操作简便，固定确实，手术时间短,骨折复位理想等近期优点,但远期疗效尚需进一步随访。
목적：탐토후로고정각도측괴、추궁근정봉계통치료무신경손상흉요추골절적치료효과。방법2008년10월지2012년2월，38례무신경계통증상적궤계불은정흉요단폭렬골절차무수감압적환자，채용후로고정각도측괴(-100、-50、00、50、100)、추궁근정봉계통경추궁근복위고정：무후방인대복합체손상자급여단순단절단고정，유후방인대복합체손상단상추추궁근완정자급여상추추궁근라사정고정，합병상추추궁근손상자급여상하량개추체고정，소유후방인대복합체손상자균후외측식골융합。소유병례술후1～3천대지구하지활동。소유병례균행술전、술후 X 선편급 CT、MRI 소묘。결과32례획득료완정적수방，수방시간4～40개월，평균28.2개월，무단정、단봉、내고정실효；평균수술시간92(82.6±19.2) min；술후상추고도유술전평균41.6%，회복도술후평균91.2%；후철Cobb’s각유술전평균35.3°，회복도술후평균7.8°；시상면위이유술전평균(32.7±7.6)％，회복도술후(8.7±4.9)％( P＜0.05)。결론고정각도측괴、추궁근정봉계통시치료무신경손상궤계불은정흉요단폭렬골절적일충유효방법，해고정계통구유결구간단，조작간편，고정학실，수술시간단,골절복위이상등근기우점,단원기료효상수진일보수방。
Objective To investigate the curative results of fixed-angle lateral masses in the posterior approach and the pedicle screw and rod system in the treatment of thoracolumbar fractures without nerve injuries. Methods From October 2008 to February 2012, 38 patients who had thoracolumbar burst fractures without neurological symptoms or decompression and with mechanical instability were included in the study. They were treated by the ifxed-angle lateral masses in the posterior approach (-100,-50, 00, 50 and 100 ) and reduction and ifxation of the pedicle screw and rod system. Single short-segment ifxation was performed on the patients without posterior ligamentous complex injuries. Pedicle screw ifxation at the injured level was performed on the patients with posterior ligamentous complex injuries and complete pedicle at the injured level. The patients with combined pedicle injuries at the injured level underwent ifxation of 2 vertebral bodies up and down. Posterolateral fusion was achieved in all patients with posterior ligamentous complex injuries. Wearing a brace, all patients were able to walk at 1-3 days after the operation. The preoperative and postoperative X-ray, CT and MRI data of all patients were reviewed. Results All patients were followed up thoroughly for a mean period of 28.2 months ( range;4-40 months ). No breakage of screws or rods or the failure of internal ifxation occurred. The mean operation time was 92 ( 82.6±19.2 ) minutes. The mean height of injured vertebral bodies was 41.6% preoperatively, which was increased to 91.2% postoperatively. The mean Cobb’s angle was 35.3° preoperatively, which was decreased to 7.8° postoperatively. The mean sagittal plane displacement was ( 32.7±7.6 )%preoperatively, which was decreased to ( 8.7±4.9 )%postoperatively ( P<0.05 ). Conclusions It is an ideal treatment method of the fixed-angle lateral masses and pedicle screw and rod system for thoracolumbar burst fractures without nerve injuries and with mechanical instability, with the recent advantages of simple construction, convenient operation, high stability, short operation time, satisfactory reduction and so on.However, the further follow-up is still necessary to evaluate the long-term results.