CAJ | 학술논문

背景：胸腰椎骨折的保守与传统开放复位内固定治疗均存在诸多不足，微创经皮椎弓根钉棒系统为胸腰椎骨折治疗提供了新的方法。 　　目的：观察Sextant经皮椎弓根螺钉微创系统治疗胸腰椎骨折的临床效果。 　　方法：共纳入55例患者，均因单个椎体的单纯压缩性骨折于2011年2月至2013年1月在武汉大学人民医院骨科分别行经皮椎弓根螺钉微创固定和传统开放复位内固定。所有患者均无神经症状和体征。Sextant微创内固定组25例，开放复位内固定组30例。记录并比较2组手术时间、术中失血量、内固定后引流量、住院时间、内固定前后矢状位Cobb角和椎体前缘高度百分比。 　　结果与结论：除开放复位内固定组2例患者出院后失访外，其余患者均获得随访，总随访时间为8-14个月。微创内固定组患者的手术时间、术中失血量、内固定后引流量和住院天数均显著优于开放复位内固定组(P=0.0000)；2组患者内固定后1周矢状位Cobb 角显著低于内固定前(P=0.0000)，椎体前缘高度百分比显著高于内固定前(P=0.0000)；2组内固定后8个月随访时的矫正丢失量差异无显著性意义。提示Sextant经皮椎弓根螺钉微创系统治疗胸腰椎(T 11-L 5)单节段椎体骨折矫正效果满意，但临床应用时需掌握其准确适应证。
배경：흉요추골절적보수여전통개방복위내고정치료균존재제다불족，미창경피추궁근정봉계통위흉요추골절치료제공료신적방법。 　　목적：관찰Sextant경피추궁근라정미창계통치료흉요추골절적림상효과。 　　방법：공납입55례환자，균인단개추체적단순압축성골절우2011년2월지2013년1월재무한대학인민의원골과분별행경피추궁근라정미창고정화전통개방복위내고정。소유환자균무신경증상화체정。Sextant미창내고정조25례，개방복위내고정조30례。기록병비교2조수술시간、술중실혈량、내고정후인류량、주원시간、내고정전후시상위Cobb각화추체전연고도백분비。 　　결과여결론：제개방복위내고정조2례환자출원후실방외，기여환자균획득수방，총수방시간위8-14개월。미창내고정조환자적수술시간、술중실혈량、내고정후인류량화주원천수균현저우우개방복위내고정조(P=0.0000)；2조환자내고정후1주시상위Cobb 각현저저우내고정전(P=0.0000)，추체전연고도백분비현저고우내고정전(P=0.0000)；2조내고정후8개월수방시적교정주실량차이무현저성의의。제시Sextant경피추궁근라정미창계통치료흉요추(T 11-L 5)단절단추체골절교정효과만의，단림상응용시수장악기준학괄응증。
BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method. OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre-and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups. RESULTS AND CONCLUSION:Except two patients in open pedicle screw fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.