CAJ | 학술논문

　　目的：探讨经肌间隙微创入路、自制器械经椎弓根伤椎植骨、伤椎置钉手术在治疗胸腰椎骨折中的有效性和安全性。方法：2008年7月-2010年12月期间笔者所在科收治胸腰段椎体骨折患者共60例，采用肌间隙微创入路、自制器械经椎弓根伤椎植骨、伤椎置钉手术治疗。结果：患者伤椎植骨及伤椎置钉术中均顺利完成，手术时间75~105 min，平均93 min；术中出血量100~180 ml，平均110 ml，切口愈合良好，无切口感染。术后随访12~20个月，平均18个月，未出现手术后长时间背痛，仅4例患者轻度酸痛，药物治疗即可缓解，对工作生活无明显影响，未出现明显“蛋壳”样骨缺损，未出现钉棒松动或断裂现象。椎体前缘高度由术前平均55.3%恢复至90.1%，后凸角由术前平均23.5°矫正至6.1°，椎管占位率由术前平均32.4%恢复至5.4%；神经功能恢复除2例D级无变化外，其余均恢复至E级。结论：采用肌间隙微创入路、自制器械经椎弓根伤椎植骨、伤椎置钉手术治疗胸腰段椎体骨折具有组织损伤轻，出血少，可有效地防止内固定失败、脊柱骨折复位丢失、后凸畸形，降低手术创伤导致的椎旁肌退变及术后腰背痛的发生率。
　　목적：탐토경기간극미창입로、자제기계경추궁근상추식골、상추치정수술재치료흉요추골절중적유효성화안전성。방법：2008년7월-2010년12월기간필자소재과수치흉요단추체골절환자공60례，채용기간극미창입로、자제기계경추궁근상추식골、상추치정수술치료。결과：환자상추식골급상추치정술중균순리완성，수술시간75~105 min，평균93 min；술중출혈량100~180 ml，평균110 ml，절구유합량호，무절구감염。술후수방12~20개월，평균18개월，미출현수술후장시간배통，부4례환자경도산통，약물치료즉가완해，대공작생활무명현영향，미출현명현“단각”양골결손，미출현정봉송동혹단렬현상。추체전연고도유술전평균55.3%회복지90.1%，후철각유술전평균23.5°교정지6.1°，추관점위솔유술전평균32.4%회복지5.4%；신경공능회복제2례D급무변화외，기여균회복지E급。결론：채용기간극미창입로、자제기계경추궁근상추식골、상추치정수술치료흉요단추체골절구유조직손상경，출혈소，가유효지방지내고정실패、척주골절복위주실、후철기형，강저수술창상도치적추방기퇴변급술후요배통적발생솔。
Objective:To evaluate the muscle gap minimally invasive approach,self-made appliance transpedicular bone graft,pedicle screws efficacy and safety of operation in the treatment of thoracolumbar fractures.Method:From July 2008 to December 2010,the intermuscular minimally invasive approach,self-made appliance transpedicular bone graft,pedicle screws operation treatment was given 60 cases patients of thoracolumbar vertebral fractures. Result:Patients with vertebral bone graft and vertebral pedicle screw surgery were successfully completed,operation time of 75-105 min,93 min on average;the intraoperative blood loss was 100-180 ml,110 ml on average,incision healed well,no incision infection. Patients were followed up for 12-20 months,average 18 months after operation,no long time back pain,only 4 cases of patients with mild pain,drug treatment could alleviate,had no significant effect on the working life,no obvious“eggshell”bone defect,no screw loosening or fracture phenomena. The anterior height of vertebral body by preoperative average 55.3%to 90.1%recovery,preoperative kyphosis correction was an average of 23.5°to 6.1°,occupying ratio was preoperative average of 32.4%to 5.4%;the recovery of neural function in addition was no change in 2 cases of grade D,the rest recovered to E grade.Conclusion:The muscle gap minimally invasive approach,self-made appliance transpedicular bone graft,pedicle screws operation in treatment of thoracolumbar vertebral fracture with tissue injury,less bleeding,can effectively prevent the failure of internal fixation,spinal fracture reduction loss, kyphosis,reduce operation trauma leads to the paraspinal muscle degeneration and operation the incidence of low back pain etc.