CAJ | 학술논문

目的探讨获得胸腰椎爆裂性骨折正常矢状曲度的方法及其临床应用疗效.方法对2010年6月至2012年1月收治的69例胸腰椎爆裂性骨折患者的临床资料进行回顾性研究,男41例,女28例；年龄18 ～71岁,平均39.3岁.骨折节段:T116例,T12 22例,L120例,L2 12例,L36例,L4 3例；术前神经功能按美国脊髓损伤协会分级(ASIA):A级2例,B级4例,C级8例,D级20例,E级35例.术前模拟手术恢复胸腰椎正常矢状曲度并测量其数值,术中通过椎弓根螺钉与上终板平行,按术前测量数值个体化预弯连接棒角度个体化恢复胸腰椎正常矢状曲度.记录并比较患者术前、术后即刻、末次随访时的伤椎前缘高度比值、固定节段矢状曲度丧失角度及椎管占位程度. 结果本组患者手术时间100 ～ 200min,平均137min；所有患者术后获12 ～ 25个月(平均14.3个月)随访.术后即刻和末次随访时的椎体前缘高度比值、固定节段矢状曲度丧失角度及椎管占位程度与术前比较差异均有统计学意义(P＜0.05),而末次随访时与术后即刻比较差异均无统计学意义(P＞0.05).均未见内固定松动、断裂发生,脊髓神经功能障碍术后无加重,67例不全截瘫患者ASIA分级均有1级以上改善. 结论通过术前模拟手术个体化测量正常矢状曲度,按术前测量数值个体化预弯连接棒角度可以更好地恢复胸腰椎爆裂性骨折的椎体高度及矢状曲度,正常矢状曲度的恢复可以明显减少术后固定节段矢状角度的丢失和内固定断裂、松动的发生.
목적 탐토획득흉요추폭렬성골절정상시상곡도적방법급기림상응용료효.방법 대2010년6월지2012년1월수치적69례흉요추폭렬성골절환자적림상자료진행회고성연구,남41례,녀28례；년령18 ～71세,평균39.3세.골절절단:T116례,T12 22례,L120례,L2 12례,L36례,L4 3례；술전신경공능안미국척수손상협회분급(ASIA):A급2례,B급4례,C급8례,D급20례,E급35례.술전모의수술회복흉요추정상시상곡도병측량기수치,술중통과추궁근라정여상종판평행,안술전측량수치개체화예만련접봉각도개체화회복흉요추정상시상곡도.기록병비교환자술전、술후즉각、말차수방시적상추전연고도비치、고정절단시상곡도상실각도급추관점위정도. 결과 본조환자수술시간100 ～ 200min,평균137min；소유환자술후획12 ～ 25개월(평균14.3개월)수방.술후즉각화말차수방시적추체전연고도비치、고정절단시상곡도상실각도급추관점위정도여술전비교차이균유통계학의의(P＜0.05),이말차수방시여술후즉각비교차이균무통계학의의(P＞0.05).균미견내고정송동、단렬발생,척수신경공능장애술후무가중,67례불전절탄환자ASIA분급균유1급이상개선. 결론 통과술전모의수술개체화측량정상시상곡도,안술전측량수치개체화예만련접봉각도가이경호지회복흉요추폭렬성골절적추체고도급시상곡도,정상시상곡도적회복가이명현감소술후고정절단시상각도적주실화내고정단렬、송동적발생.
Objective To explore the methods of measuring the normal sagittal curvature individually and its clinical application in the treatment of thoracolumbar burst fractures.Methods From June 2010 through January 2012,69 patient with thoracolumbar burst fracture were treated in our department.They were 41 men and 28 women,aged from 18 to 71 years (mean,39.3 years).Fracture levels:T11 in 6,T12in 22,L1 in 20,L2 in 12,L3 in 6,and L4 in 3 cases.The preoperative neural function by the American Spinal Injury Association (ASIA) system:grade A in 2,grade B in 4,grade C in 8,grade D in 20 and grade E in 35 cases.In the individualized surgical simulation before operation,the restored normal sagittal curvature of the patient was measured and the values were used for pre-bending of the connection rod.The compression ratio of anterior border heights of the injured vertebra,angle of sagittal curvature loss of the fixated segment and spinal canal compromise were recorded and compared preoperation,immediate post-operation and at the last follow-up.Results The operation time ranged from 100 to 200 minutes in this series (average,137minutes).All the patients were followed up for 12 to 25 months (average,14.3 months).There were significant differences between preoperation and postoperation regarding the compression ratio of anterior border heights of the injured vertebra,angle of sagittal curvature loss of the fixated segment and spinal canal compromise (P ＜ O.05),but no significant differences between immediate postoperation and last follow-up (P ＞ 0.05).There was no breakage of the pedicle screw or loosening of the implant.The neural malfunction did not deteriorate post-operation.All the 67 patients with incomplete paraplegia had more than one grade improvement in ASIA grading.Conclusions Individual measurement of normal sagittal curvature in a surgical simulation before operation can yield valuable values for prebending of the connection rod to facilitate better restoration of vertebral height and sagittal curvature in the treatment of thoracolumbar burst fracture.Recovery of normal sagittal curvature can significantly reduce loss of sagittal angle of the fixated segment and breakage and loosening of implants.