CAJ | 학술논문

目的：观察椎弓根植骨联合短节段椎弓根螺钉内固定治疗老年胸腰椎骨折的疗效及安全性。方法选取采用椎弓根植骨联合短节段椎弓根螺钉内固定治疗的老年胸腰段骨折病例进行回顾性分析，共纳入56例研究对象。手术前后及随访期间均行X线检查，观察术后植骨情况、并发症发生率及神经功能恢复情况，评估手术前后伤椎椎体前缘高度值、Cobb's角、椎管内占位变化等。结果手术时间平均为(136±41) min；术中平均出血量(250±61) ml，术后无感染、骨不连等严重并发症。随访时间6~60个月，术后影像学检查伤椎高度、Cobb's角、椎管内占位较术前获得显著改善(P<0.05)，术后1周与末次随访时差异无统计学意义。术后ASIA分级与术前比较差异有统计学意义(P<0.05)，神经功能获得1~2级改善。结论短节段椎弓根螺钉内固定可重建脊柱稳定性，椎弓根植骨可填补伤椎复位后的椎体缺损，维持前中后三柱稳定性，是治疗老年胸腰椎骨折的有效方法。
목적：관찰추궁근식골연합단절단추궁근라정내고정치료노년흉요추골절적료효급안전성。방법선취채용추궁근식골연합단절단추궁근라정내고정치료적노년흉요단골절병례진행회고성분석，공납입56례연구대상。수술전후급수방기간균행X선검사，관찰술후식골정황、병발증발생솔급신경공능회복정황，평고수술전후상추추체전연고도치、Cobb's각、추관내점위변화등。결과수술시간평균위(136±41) min；술중평균출혈량(250±61) ml，술후무감염、골불련등엄중병발증。수방시간6~60개월，술후영상학검사상추고도、Cobb's각、추관내점위교술전획득현저개선(P<0.05)，술후1주여말차수방시차이무통계학의의。술후ASIA분급여술전비교차이유통계학의의(P<0.05)，신경공능획득1~2급개선。결론단절단추궁근라정내고정가중건척주은정성，추궁근식골가전보상추복위후적추체결손，유지전중후삼주은정성，시치료노년흉요추골절적유효방법。
Objective To explore the clinical efficacy of transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra to treat thoracolumbar fractures in elderly patients. Methods A total of 56 elderly patients with thoracolumbar fractures treated with transpedicular intracorporeal graft-ing combined with posterior short-segment pedicle screw via the injured vertebra were studied retrospectively. Preop-erative, postoperative and follow-up X-ray were performed to evaluate anterior heights of the injured vertebra (AHIV) and Cobb's angle, as well, preoperative and postoperative CT scans were taken to measure the sagittal canal diameter (SCD). Postoperative complications and neurofunctional recovery of the spinal cord were evaluated. Results The mean operation time and blooding volume were (136 ± 41) min and (250 ± 61) ml respectively. There was no infec-tion, implant failure or loss of spinal curvatures happened. All cases had been followed up for 6 to 60 months, and an-terior heights of the injured vertebra showed good recovery, and Cobb's angel appeared smaller. The sagittal canal di-ameter significantly reduced compared to that before surgery, and the neuro-functions showed 1 to 2 grade improve-ment compared to pre-operation. Conclusion Transpedicular intracorporeal grafting is effective to repair fractured vertebrae in the vertebral body defects, posterior short-segment pedicle screw via the injured vertebra can reconstruct the stability of thoracolumbar fractures, stabilize reconstruction of the anterior and middle columns and secured fixa-tion of the posterior column.