CAJ | 학술논문

目的：通过CT观察不同椎弓根骨折类型的置钉情况来探讨经伤椎置钉治疗胸腰椎骨折的安全性。方法选取我院2008年6月至2011年6月胸腰椎单节段骨折共56例，全部患者均采用经伤椎椎弓根置钉的后路复位内固定手术方式。术前常规行标准胸腰段DR摄片和CT扫描，运用PACS系统保存伤椎椎弓根层面的相关图像。观察伤椎椎弓根的完整性和骨折部位，并对其进行骨折分型；术后CT扫描观察伤椎椎弓根置钉情况，用Youkilis标准来评价置钉的准确率。结果椎弓根骨折类型主要分为椎弓根与椎体结合处骨折、椎弓根腰部骨折、椎弓根与椎板结合处骨折三型；56例经伤椎椎弓根置钉共105枚，其中左侧椎弓根置钉57枚，右侧置钉48枚，在伤椎单侧椎弓根置钉者7例。术后CT影像发现：在伤椎椎弓根置入的105枚螺钉中，有98枚螺钉完全位于椎弓根骨皮质内，7枚螺钉位置出现偏差，但均未导致相应临床症状。螺钉位置按Youkilis分级：I度98枚，II度7枚，III度0枚，本组病例没有发现螺钉向椎体的上方和前方穿出。术后发生脑脊液漏1例，没有切口感染、医源性的脊髓神经功能障碍加重等并发症。末次随访时有2例发生内固定失败(钉棒松动和断裂各1例)。结论术前掌握好伤椎置钉的适应证并根据CT制定个体化的手术计划，术中把握好进钉点、方向和螺钉大小及长度等因素，经伤椎椎弓根置钉是安全和可行的，不增加并发症，是临床上治疗胸腰椎骨折的一种可靠方法。
목적：통과CT관찰불동추궁근골절류형적치정정황래탐토경상추치정치료흉요추골절적안전성。방법선취아원2008년6월지2011년6월흉요추단절단골절공56례，전부환자균채용경상추추궁근치정적후로복위내고정수술방식。술전상규행표준흉요단DR섭편화CT소묘，운용PACS계통보존상추추궁근층면적상관도상。관찰상추추궁근적완정성화골절부위，병대기진행골절분형；술후CT소묘관찰상추추궁근치정정황，용Youkilis표준래평개치정적준학솔。결과추궁근골절류형주요분위추궁근여추체결합처골절、추궁근요부골절、추궁근여추판결합처골절삼형；56례경상추추궁근치정공105매，기중좌측추궁근치정57매，우측치정48매，재상추단측추궁근치정자7례。술후CT영상발현：재상추추궁근치입적105매라정중，유98매라정완전위우추궁근골피질내，7매라정위치출현편차，단균미도치상응림상증상。라정위치안Youkilis분급：I도98매，II도7매，III도0매，본조병례몰유발현라정향추체적상방화전방천출。술후발생뇌척액루1례，몰유절구감염、의원성적척수신경공능장애가중등병발증。말차수방시유2례발생내고정실패(정봉송동화단렬각1례)。결론술전장악호상추치정적괄응증병근거CT제정개체화적수술계화，술중파악호진정점、방향화라정대소급장도등인소，경상추추궁근치정시안전화가행적，불증가병발증，시림상상치료흉요추골절적일충가고방법。
Objective To investigate the safety of the treatment of thoracolumbar fractures by placing screws in the injured vertebra through observing the screw placement for different types of pedicle fractures based on the Computed Tomography ( CT ) images.Methods 56 patients with single-segment thoracolumbar fractures underwent the treatment of posterior internal ifxation with screws placed in the injured vertebra from June 2008 to June 2011 in our hospital. Preoperatively the standard Digital Radiography ( DR ) and CT were performed routinely in all the patients. Relevant images of the injured pedicles were kept by the picture archiving and communication system ( PACS ). The integrity and position of the fractured pedicles were observed, and the types of fractures were classiifed. Postoperatively the placed screws were observed based on the CT images. The Youkilis standard was used to evaluate the accuracy of pedicle screws.Results Pedicle fractures were divided into 3 main types, including fractures of the junction of pedicle and vertebra, pedicle waist fractures and fractures of the junction of pedicle and lamina. 105 pedicle screws were placed in 56 patients, with 57 screws at the left side and 48 screws at the right side. Unilateral pedicle screws were used in 7 patients. The postoperative CT images showed 98 screws were placed in the bone cortex completely and 7 screws were deviated, without any relevant clinical symptoms. The screw position was graded by the Youkilis standard, including I degree in 98 cases, II degree in 7 cases, III degree in 0 case. In this group, such screws to be above or in front of the vertebral body were not found. 1 patient had cerebrospinal lfuid leakage postoperatively, but no complications such as incision infection or the exacerbation of iatrogenic spinal cord dysfunction occurred. The failure of internal ifxation was noticed in 2 cases in the latest follow-up ( screw loosening and breakage in 1 case respectively ).Conclusions The placement of screws in the injured vertebra is a safe, feasible and reliable method in the clinical treatment of thoracolumbar fractures, with the complications not increased. However, the indications of placing pedicle screws should be mastered preoperatively, and the nail point and direction and the screw size and length should be grasped during the surgery, with the individualized surgical plan made based on the CT images.