CAJ | 학술논문

目的：探讨小切口减压结合经皮椎弓根螺钉内固定治疗伴神经功能损害胸腰椎骨折的安全性及有效性。方法：2010年12月～2013年10月对18例伴神经功能损害的胸腰椎骨折患者在全麻下行经皮椎弓根螺钉置入、后正中小切口进行神经减压、椎间植骨融合、骨折复位固定术，并加装横连接（微创手术组）。其中男12例，女6例；年龄30~58岁，平均42.8岁；T123例，L16例，L24例，L35例；AO分型A3型3例，C1型14例，C2型2例；神经功能Frankel分级A级5例，B级9例，C级2例，D级2例。记录肌肉剥离切口长度、手术时间、术中出血量、术后引流量、术后伤口疼痛程度和镇痛药物使用情况及减压等并与同期20例传统开放手术患者（开放手术组）情况比较。结果：微创手术组肌肉剥离长度为6.9±1.2cm，术中出血量为538.3±188.7ml，术后引流量为116.4±55.0ml，术后伤口疼痛VAS评分为2.5±1.4分，术后镇痛药物使用比例为16.7%；开放手术组分别为18.6±2.8cm，735.8±252.2ml，233.5±95.8ml，4.4±1.8分和70.0%，两组比较差异均有统计学意义（P<0.05或P<0.01）。两组均无手术并发症发生，椎管得到有效减压。两组均获得最少6个月以上随访，两组不完全瘫患者术后均获得1级及以上神经功能恢复。结论：后正中小切口减压结合经皮椎弓根螺钉内固定术在确保良好神经减压的同时能够明显减少手术创伤，且能安放横连接，是治疗伴神经功能损害胸腰椎骨折安全、有效、微创的手术方法。
목적：탐토소절구감압결합경피추궁근라정내고정치료반신경공능손해흉요추골절적안전성급유효성。방법：2010년12월～2013년10월대18례반신경공능손해적흉요추골절환자재전마하행경피추궁근라정치입、후정중소절구진행신경감압、추간식골융합、골절복위고정술，병가장횡련접（미창수술조）。기중남12례，녀6례；년령30~58세，평균42.8세；T123례，L16례，L24례，L35례；AO분형A3형3례，C1형14례，C2형2례；신경공능Frankel분급A급5례，B급9례，C급2례，D급2례。기록기육박리절구장도、수술시간、술중출혈량、술후인류량、술후상구동통정도화진통약물사용정황급감압등병여동기20례전통개방수술환자（개방수술조）정황비교。결과：미창수술조기육박리장도위6.9±1.2cm，술중출혈량위538.3±188.7ml，술후인류량위116.4±55.0ml，술후상구동통VAS평분위2.5±1.4분，술후진통약물사용비례위16.7%；개방수술조분별위18.6±2.8cm，735.8±252.2ml，233.5±95.8ml，4.4±1.8분화70.0%，량조비교차이균유통계학의의（P<0.05혹P<0.01）。량조균무수술병발증발생，추관득도유효감압。량조균획득최소6개월이상수방，량조불완전탄환자술후균획득1급급이상신경공능회복。결론：후정중소절구감압결합경피추궁근라정내고정술재학보량호신경감압적동시능구명현감소수술창상，차능안방횡련접，시치료반신경공능손해흉요추골절안전、유효、미창적수술방법。
Objectives: To determine the safety and efficacy of posterior mini-open technique combined with percutaneous pedicle screw instrumentation for thoracolumbar fracture complicated with neurological deficits. Methods: A retrospective review was performed on 18 patients(12 males and 6 females) with thoracolumbar fracture complicated with neurological deficits between December 2010 and October 2013. The patients were from 30 years to 58 years with an average of 42.8 years. After general anesthesia, ZINA TM percutaneous pedi-cle screws were implanted above and below the injured segment, neural tissue decompression, interbody fusion with autograft, and reduction was performed under posterior mini-open approach(MISS group). Compared with the other 20 cases undergoing traditional open surgery (TOS group), the length of soft tissue dissection, the blood loss during surgery, the drainages, the visual analog score (VAS) of incision and analgesics usage after surgery were evaluated separately. Results: Compared with TOS group, the length of soft tissue dissection was 6.9±1.2cm vs. 18.6±2.8cm, the blood loss during surgery was 538.3±188.7ml vs. 735.8±252.2ml, the drainage was 116.4±55.0ml vs. 233.5±95.8ml, the visual analog score(VAS) of incision was 2.5±1.4 vs. 4.4±1.8 and analgesics usage after surgery was 16.7% vs. 70.0%. All showed significant differences between two groups(P<0.05 or P<0.01). No surgery related complains were found. All patients achieved effective decompression. In two groups, more than 6 months were followed up, and more than one grade of neurofunction recovery was observed at final follow-up. Conclusions: Posterior mini-open technique combined with percutaneous pedicle screw instrumentation provides a safe, effective and less invasive alternative for dealing thoracolumbar fracture complicated with neurological deficits.