CAJ | 학술논문

目的比较后外侧融合与不融合在经伤椎固定治疗无脊髓损伤的胸腰椎A3型骨折中的疗效. 方法回顾性分析2001年1月至2010年10月56例无脊髓损伤的AO分型为A3型胸腰椎骨折患者的临床资料,按手术方式不同分为两组:融合组34例,男20例,女14例；平均(36.2±7.3)岁；伤椎分布:T112例,T12 10例,L1l4例,L28例,行后路复位经伤椎椎弓根螺钉内固定术,并取自体髂骨或同种异体骨行后外侧融合术；不融合组22例,男13例,女9例；平均(34.6±7.4)岁；伤椎分布:T112例,T128例,L110例,L22例,仅行后路复位经伤椎椎弓根螺钉内固定术.两组患者术前一般资料差异无统计学意义(p＞0.05),具有可比性.分别于术前、术后即刻、术后1年和术后2年随访,对两组患者的影像学指标与临床疗效进行比较.结果所有患者术后获24 ～ 84个月(平均35.6个月)的随访.两组患者手术时间[(104.1±8.5)min比(99.1±11.8) min]、出血量[(199.1 ±63.7) mL比(175.5 ±60.8) mL],术后cobb角的矫正度(13.4°±7.3°比l2.6°±4.6°)、术后2年丢失度(5.1°±4.5°比3.8°±3.9°),伤椎后凸角的矫正度(9.6°±5.1°比8.2°±3.4°)、术后2年丢失度(3.4°±2.2°比2.4°±2.7°),伤椎前、后缘高度百分比矫正度(27.5％ ± 8.6％比25.6％±10.8％),(8.4％±5.1％比7.1％±5.3％)、术后2年丢失度(5.7％±4.5％比4.8％±3.6％),(2.5％±1.7％比3.2％±1.1％),椎管矢状径复位度比较差异均无统计学意义(p＞0.05).两组患者术前、术后、术后1年和术后2年的Oswestry功能障碍指数问卷表评分与视觉模拟评分比较差异均无统计学意义(P＞ 0.05).术后除融合组l例发生断钉外,其他患者均未出现神经损伤及与伤椎置钉相关的并发症. 结论对于无脊髓损伤的胸腰椎A3型骨折,后外侧融合与不融合经伤椎椎弓根螺钉固定疗效相当.
목적 비교후외측융합여불융합재경상추고정치료무척수손상적흉요추A3형골절중적료효. 방법 회고성분석2001년1월지2010년10월56례무척수손상적AO분형위A3형흉요추골절환자적림상자료,안수술방식불동분위량조:융합조34례,남20례,녀14례；평균(36.2±7.3)세；상추분포:T112례,T12 10례,L1l4례,L28례,행후로복위경상추추궁근라정내고정술,병취자체가골혹동충이체골행후외측융합술；불융합조22례,남13례,녀9례；평균(34.6±7.4)세；상추분포:T112례,T128례,L110례,L22례,부행후로복위경상추추궁근라정내고정술.량조환자술전일반자료차이무통계학의의(p＞0.05),구유가비성.분별우술전、술후즉각、술후1년화술후2년수방,대량조환자적영상학지표여림상료효진행비교.결과소유환자술후획24 ～ 84개월(평균35.6개월)적수방.량조환자수술시간[(104.1±8.5)min비(99.1±11.8) min]、출혈량[(199.1 ±63.7) mL비(175.5 ±60.8) mL],술후cobb각적교정도(13.4°±7.3°비l2.6°±4.6°)、술후2년주실도(5.1°±4.5°비3.8°±3.9°),상추후철각적교정도(9.6°±5.1°비8.2°±3.4°)、술후2년주실도(3.4°±2.2°비2.4°±2.7°),상추전、후연고도백분비교정도(27.5％ ± 8.6％비25.6％±10.8％),(8.4％±5.1％비7.1％±5.3％)、술후2년주실도(5.7％±4.5％비4.8％±3.6％),(2.5％±1.7％비3.2％±1.1％),추관시상경복위도비교차이균무통계학의의(p＞0.05).량조환자술전、술후、술후1년화술후2년적Oswestry공능장애지수문권표평분여시각모의평분비교차이균무통계학의의(P＞ 0.05).술후제융합조l례발생단정외,기타환자균미출현신경손상급여상추치정상관적병발증. 결론대우무척수손상적흉요추A3형골절,후외측융합여불융합경상추추궁근라정고정료효상당.
Objective To compare the therapeutic effects of posterolateral fusion and non-fusion treatment for thoracolumbar A3 fractures without neurologic deficit.Methods We retrospectively analyzed 56 patients with type A3 thoracolumbar fracture without neurologic deficit who had been treated in our department from January 2001 to Octoher 2010.In the fusion group,there were 34 cases,20 males and 14females with a mean age of 36.2 ±7.3 years.The injured vertebrae involved Tll in 2 cases,T12 in 10,L1in 14 and L2 in 8.They were treated with posterior reduction and pedicle screw fixation across the injured vertebra followed by posterolateral fusion with iliac or allograft bone.In the non-fusion group,there were 22cases,13 males and 9 females with a mean age of 34.6 ± 7.4 years.The injured vertebrae involved T1 1 in 2cases,T12 in 8,L1 in 10 and L2 in 2.They were treated only with posterior reduction and pedicle screw fixation across the injured vertebra.There was no significent difference between groups in the general data of the patients.The 2 groups were compared in terms of radiographic measurements and clinical effects preoperation,immediate postoperation,1 and 2 years postoperation.Results All patients were followed up from 24 to 84 months (mean,35.6 months).There were no significant differences between the 2 groups regarding operation time (104.1 ±8.5 minutes versus 99.1 ± 11.8 minutes),blood loss (199.1 ±63.7 mL versus 175.5 ±60.8 mL),postoperative correction of cobb's angle (13.4° ±7.3° versus 12.6°±4.6°),correction loss of the cobb's angle at 2-year follow-up (5.7° ± 4.5° versus 4.8° ± 3.6°),postoperative correction of kyphotic angle of the injured vertebra (9.6° ± 5.1 ° versus 8.2° ± 3.4°),correction loss of the kyphotic angle at 2-year follow-up (3.4° ± 2.2° versus 2.4° ± 2.7°),restoration of anterior height of the fractured vertebra(27.5％ ± 8.6％ versus 25.6％ ± 10.8％),correction loss of the anterior height at 2-year follow-up (5.1％ ± 4.5％ versus 3.8％ ± 3.9％),restoration of posterior height of the fractured vertebra (8.4％ ±5.1％ versus 7.1％ ±5.3％),correction loss of the posterior height at 2 year follow-up (2.5％ ±1.7％ versus 3.2％ ± 1.1％),or reduction of the canal sagittal diameter (all P ＞ 0.05) There were no significant differences in mean Oswestry disability index (ODI) or visual analogue scale (VAS) scores between the 2 groups preoperation,immediate postoperation,1 and 2 years postoperation (all P ＞ 0.05) There were no severe neurologic complications or other complications related to internal fixation except implant breakage in one case in the fusion group.Conclusion For thoracolumbar A3 fractures without neurologic deficit,posterolateral fusion and non-fusion treatment are similar in therapeutic effects.