CAJ | 학술논문

目的探讨小切口椎旁肌间隙入路并经伤椎椎弓根植骨内固定治疗胸腰椎骨折的安全性及有效性. 方法选择2009年6月-2012年6月采用椎旁小切口经多裂肌间隙入路并经伤椎椎弓根植骨、短节段椎弓根螺钉固定治疗23例胸腰椎骨折患者,其中男16例,女7例；年龄19～55岁,平均38.8岁.受伤至手术时间6h～7d,平均3.2d.损伤节段:T113例,T12 7例,L19例,L24例.依据Denis骨折分型,压缩性骨折10例,爆裂骨折13例.McCormack载荷分享分类法评分平均5.3分.术前椎体前缘高度45％～ 73％,平均58.6％.Cobb角15°～34°,平均23.7°. 结果手术时间75～130 min,平均95.5 min；术中出血量115 ～ 220 ml,平均160.3 ml;单侧切口长度3.2 ～4.0 cm,平均3.5 cm,手术切口均I期愈合.术后随访7.5～18个月,平均12.6个月.椎体前缘高度平均恢复至97.3％,平均后凸矫正至4.6°.所有患者未发现内固定失效及明显腰背部疼痛症状. 结论小切口椎旁肌间隙入路经伤椎椎弓根植骨内固定可有效恢复骨折椎体形态,矫正后凸畸形,具有操作简单、组织损伤轻、出血少、患者恢复快等优点.
목적 탐토소절구추방기간극입로병경상추추궁근식골내고정치료흉요추골절적안전성급유효성. 방법 선택2009년6월-2012년6월채용추방소절구경다렬기간극입로병경상추추궁근식골、단절단추궁근라정고정치료23례흉요추골절환자,기중남16례,녀7례；년령19～55세,평균38.8세.수상지수술시간6h～7d,평균3.2d.손상절단:T113례,T12 7례,L19례,L24례.의거Denis골절분형,압축성골절10례,폭렬골절13례.McCormack재하분향분류법평분평균5.3분.술전추체전연고도45％～ 73％,평균58.6％.Cobb각15°～34°,평균23.7°. 결과 수술시간75～130 min,평균95.5 min；술중출혈량115 ～ 220 ml,평균160.3 ml;단측절구장도3.2 ～4.0 cm,평균3.5 cm,수술절구균I기유합.술후수방7.5～18개월,평균12.6개월.추체전연고도평균회복지97.3％,평균후철교정지4.6°.소유환자미발현내고정실효급명현요배부동통증상. 결론 소절구추방기간극입로경상추추궁근식골내고정가유효회복골절추체형태,교정후철기형,구유조작간단、조직손상경、출혈소、환자회복쾌등우점.
Objective To test the safety and effectiveness of transpedicular fixation combined with transpedicular bone grafting via less invasive paraspinal intermusclar approach in treatment of thoracolumbar fractures.Methods The study involved 23 cases of thoracolumbar fractures treated with paraspinal multifidus intramusclular mini-incision,transpedicular bone grafting,and short-segment pedicle screw fixation from June 2009 to June 2012.There were 16 males and 7 females at age of 19-55 years (average 38.8years).Time from injury to surgery varied from 6 hours to 7 days (average 3.2 days).Fracture level was T11 in three cases,T12 in seven,L1 in nine,and L2 in four.According to Denis fracture classification,there were altogether 10 compression fractures and 13 burst fractures.McCormack load sharing classification scored average 5.3.Before operation,anterior vertebral body height ratio was average 58.6％(range,45 ％-73％) and kyphosis angle was average 23.7° (range,15°-34°).Results Operation lasted for average 95.5 minutes (range,75-130 minutes) with intraoperative bleeding of average 160.3 ml (range,115-220 ml).Unilateral incision that was averaged 3.5 cm (range 3.2-4.0 cm) in length obtained primary healing.Average follow-up time was 12.6 months (range,7.5-18 months).Average height of the anterior border was corrected to 97.3％ and average kyphosis angle was corrected to 4.6°.There was neither instrumentation failure nor symptom of persistent postoperative back pain.Conclusions Transpedicular fixation with transpedicular bone grafting via paraspinal muscle approach provides effective recovery of vertebral morphology and correction of kyphotic deformity.Furthermore,the technique gains advantages of easy operation,small trauma,less blood loss and rapid recovery.