CAJ | 학술논문

目的：探讨早期后路手术对胸腰椎爆裂性骨折的治疗价值,以达到最大的椎管后凸骨块的复位，恢复脊椎序列，减少椎管狭窄,增加脊椎的稳定性。方法采用后路间接椎管扩大、短节段椎弓根螺钉固定技术,对48例（无神经症状36例，有神经症状12例）胸腰椎爆裂性骨折进行手术治疗的患者进行回顾分析,依据术中c臂观察椎管内骨块复位情况，决定是否后路椎板减压。非减压组40例，减压组8例，减压后行横突间植骨/+单侧椎板后植骨。有神经损伤12例,无神经伤36例。结果48例中无神经损伤36例均未行椎管减压,椎管侵入(37.16±15.15)%；合并神经损伤12例，椎管侵入(48.59±16.89)%,，4例未行椎管减压,8例行椎管减压，两组差异显著(P<0.05)。非减压组（40例）和减压组（8例）术前侵入椎管比例分别为(41.97±12.90)%、(43.52±16.15)%(P>0.05)。治疗后非减压组和减压组侵入椎管比例分别为(20.69±15.93)%、(27.37±12.89)%,非减压组椎管矢状径平均改善23.28%,减压组为14.15%( P<0.05)，神经损伤症状均有明显改善。结论胸腰椎爆裂性骨折引起的椎管狭窄程度与神经损伤密切相关,术中根据c臂观察椎管内骨块后凸复位情况决定是否行椎管减压，早期后路手术能大部分改善胸腰椎爆裂性骨折椎管狭窄程度，多数不需要后路减压,减少对脊椎后柱的破坏。
목적：탐토조기후로수술대흉요추폭렬성골절적치료개치,이체도최대적추관후철골괴적복위，회복척추서렬，감소추관협착,증가척추적은정성。방법채용후로간접추관확대、단절단추궁근라정고정기술,대48례（무신경증상36례，유신경증상12례）흉요추폭렬성골절진행수술치료적환자진행회고분석,의거술중c비관찰추관내골괴복위정황，결정시부후로추판감압。비감압조40례，감압조8례，감압후행횡돌간식골/+단측추판후식골。유신경손상12례,무신경상36례。결과48례중무신경손상36례균미행추관감압,추관침입(37.16±15.15)%；합병신경손상12례，추관침입(48.59±16.89)%,，4례미행추관감압,8례행추관감압，량조차이현저(P<0.05)。비감압조（40례）화감압조（8례）술전침입추관비례분별위(41.97±12.90)%、(43.52±16.15)%(P>0.05)。치료후비감압조화감압조침입추관비례분별위(20.69±15.93)%、(27.37±12.89)%,비감압조추관시상경평균개선23.28%,감압조위14.15%( P<0.05)，신경손상증상균유명현개선。결론흉요추폭렬성골절인기적추관협착정도여신경손상밀절상관,술중근거c비관찰추관내골괴후철복위정황결정시부행추관감압，조기후로수술능대부분개선흉요추폭렬성골절추관협착정도，다수불수요후로감압,감소대척추후주적파배。
Objective: To explore the therapeutic value of posterior operation early burst fractures of thoracolumbar, reduction to achieve maximum canal skeleton block, restore vertebral sequence, reduce spinal stenosis, increase the stability of spine. Methods: using indirect spinal canal, posterior short-segment pedicle screw fixation, 48 cases ( 36 cases without neurological symptoms, neurological symptoms in 12 cases ) of thoracolumbar burst fractures were retrospectively analyzed patients underwent operation treatment, based on the intraspinal bone reduction were observed in C arm, decide whether posterior decompression. Non decompression group 40 cases, decompression group 8 cases, bone graft after decompression intertransverse/ + after laminectomy. There are 12 cases of nerve injury, no nerve injury in 36 cases. Results: there was no nerve injury in 36 cases were not decompression of spinal canal in 48 cases, invasive (37.16±15.15) %; 12 cases complicated with nerve injury, spinal canal intrusion (48.59±16.89) %,, 4 cases without spinal canal decompression, 8 cases of spinal canal decompression, two groups had significant difference (P<0.05). Non decompression group (40 cases) and decompression group (8 cases) preoperative vertebral canal respectively (41.97 ±12.90) %, (43.52±16.15) % (P>0.05). After the treatment of non decompression of vertebral canal decompression group and group respectively (20.69±15.93) %, (27.37±12.89)%, non decompression group sagittal diameter of spinal canal was improved 23.28%, decompression group was 14.15% (P<0.05), the symptoms were obviously improved nerve injury. Conclusion: the thoracolumbar burst fracture injury degree of spinal canal stenosis and nerve caused by closely related, was based on the C arm of spinal bone kyphosis reduction situation to decide whether decompression, posterior operation can improve the early majority of thoracolumbar burst fracture with spinal stenosis, most do not need posterior decompression, reduction of the column of spine after the destruction of.