CAJ | 학술논문

目的探讨经伤椎单侧椎弓根固定治疗胸腰椎骨折的可行性和临床疗效.方法回顾性分析2005年1月至2010年12月应用后路椎弓根螺钉技术治疗的98例胸腰椎骨折患者的临床资料,男66例,女32例；年龄19～65岁,平均44.9岁.根据治疗方法不同分为经伤椎单侧椎弓根固定组(经伤椎组,50例)和短节段椎弓根固定组(短节段组,48例).比较两组患者的手术时间、术中出血量及术前、术后cobb角、伤椎前、后缘高度、内固定失败率. 结果所有患者术后获6～53个月(平均34个月)随访.两组患者手术时间、术中出血量比较差异无统计学意义(P＞0.05).两组患者术后cobb 角、伤椎前缘高度较术前均有明显改善,经伤椎组改善优于短节段组,差异有统计学意义(P＜0.05),术后伤椎后缘高度比较差异无统计学意义(P＞0.05);术后24个月随访两组cobb角及伤椎前缘高度均丢失,两组cobb角及伤椎前缘高度丢失率比较差异均有统计学意义(P＜0.05),两组伤椎后缘高度丢失率比较差异无统计学意义(P＞0.05).经伤椎组1例内固定装置松动,未出现内固定装置断裂,短节段组3例内固定装置松动,3例内固定装置断裂. 结论经伤椎单侧椎弓根固定治疗胸腰椎骨折能提供较单纯短节段椎弓根固定更好的复位效果和更为坚固的内固定强度.
목적 탐토경상추단측추궁근고정치료흉요추골절적가행성화림상료효.방법 회고성분석2005년1월지2010년12월응용후로추궁근라정기술치료적98례흉요추골절환자적림상자료,남66례,녀32례；년령19～65세,평균44.9세.근거치료방법불동분위경상추단측추궁근고정조(경상추조,50례)화단절단추궁근고정조(단절단조,48례).비교량조환자적수술시간、술중출혈량급술전、술후cobb각、상추전、후연고도、내고정실패솔. 결과 소유환자술후획6～53개월(평균34개월)수방.량조환자수술시간、술중출혈량비교차이무통계학의의(P＞0.05).량조환자술후cobb 각、상추전연고도교술전균유명현개선,경상추조개선우우단절단조,차이유통계학의의(P＜0.05),술후상추후연고도비교차이무통계학의의(P＞0.05);술후24개월수방량조cobb각급상추전연고도균주실,량조cobb각급상추전연고도주실솔비교차이균유통계학의의(P＜0.05),량조상추후연고도주실솔비교차이무통계학의의(P＞0.05).경상추조1례내고정장치송동,미출현내고정장치단렬,단절단조3례내고정장치송동,3례내고정장치단렬. 결론 경상추단측추궁근고정치료흉요추골절능제공교단순단절단추궁근고정경호적복위효과화경위견고적내고정강도.
Objective To study the feasibility and clinical efficacy of internal fixation of thoracolumbar fractures by unilateral pedicle screw fixation at the level of the fractured vertebra.Methods From January 2005 to December 2010,98 patients with single level thoracolumbar fracture were admitted to our hospital for surgery.They were 66 men and 32 women,with an average age of 44.9 years (from 19 to 65 years).Of them,50 cases were treated by unilateral pedicle screw fixation at the level of fractured vertebra and 48 cases by short segmental pedicle screw fixation.The operative time,intraoperative blood loss,postoperative cobb' angle,anterior and posterior margin heights of fractured vertebra and internal fixation failure were compared between the 2 groups.Results The patients were followed up for 6 to 53 months (mean,34months).There were no significant differences between the 2 groups in operative time or intraoperative blood loss (P ＞ 0.05).Compared with preoperation,the postoperative cobb' angle and anterior margin height of fractured vertebra were significantly improved in both groups and the improvements in the unilateral pedicle screw fixation group were significantly larger than in the short segmental pedicle screw fixation group (P ＜0.05),but there was no significant difference regarding the posterior margin height between preoperation and postoperation (P ＞ 0.05).Losses in cobb' angle and anterior height occurred in both groups at the follow-up 24 months postoperation.There were significant differences regarding losses in the cobb' angle and the anterior margin height of fractured vertebra (P ＜ 0.05) but there was no significant difference regarding the posterior margin height between the 2 groups (P ＞ 0.05).In the unilateral pedicle screw fixation group,one case of implant loosening happened,while in the short segment pedicle screw fixation group there were 3 cases of implant loosening and 3 cases of implant failure.Conclusion The unilateral pedicle screw fixation at the level of fractured vertebra can achieve better outcome in reduction and stability than short segment pedicle screw fixation in treatment of thoracolumbar fractures.