CAJ | 학술논문

背景：近年来微创技术理念越来越受到重视，一些新的微创方法被运用到脊柱骨折治疗中，对旧的开放式手术治疗方法提出了挑战。目的：对比观察常规后路开放经伤椎椎弓根螺钉内固定、微创内固定方式(利用 Quadrant 通道内固定和经皮Sextant内固定)治疗单节段无神经症状胸腰椎骨折的临床疗效。方法：纳入2012年1月至2013年1月于柳州市工人医院脊柱外科住院并接受内固定修复治疗的94例单节段无神经症状胸腰椎骨折患者，根据患者病情及意愿分为开放内固定组、Quadrant 通道内固定组及经皮Sextant内固定组，观察并比较各组患者的围手术期参数、临床疗效及影像学检查指标。结果与结论：Quadrant通道内固定组、经皮Sextant内固定组在术中出血量、手术切口长度、住院时间方面均优于常规后路开放内固定组(P <0.05)。94例患者均获得随访，随访时间为6个月，无脱钉、断钉及神经损伤现象。3组伤椎内固定后椎体前缘高度、Cobbs角、矢状位指数与内固定前相比较均有明显改善(P<0.05)，但3组之间比较差异无显著性意义(P >0.05)。两微创组内固定后目测类比评分、Oswestry功能障碍指数均优于常规开放内固定组(P<0.05)。提示与传统的开放内固定相比，微创(经皮Sextant内固定及利用Quadrant通道内固定)治疗胸腰椎骨折不仅能取得与之相当的影像学效果，而且具有创伤小、出血少、恢复快、安全性高的优点，有更好的临床疗效。在严格掌握手术适应证情况下，微创方法是治疗无神经损伤胸腰椎骨折的理想选择。
배경：근년래미창기술이념월래월수도중시，일사신적미창방법피운용도척주골절치료중，대구적개방식수술치료방법제출료도전。목적：대비관찰상규후로개방경상추추궁근라정내고정、미창내고정방식(이용 Quadrant 통도내고정화경피Sextant내고정)치료단절단무신경증상흉요추골절적림상료효。방법：납입2012년1월지2013년1월우류주시공인의원척주외과주원병접수내고정수복치료적94례단절단무신경증상흉요추골절환자，근거환자병정급의원분위개방내고정조、Quadrant 통도내고정조급경피Sextant내고정조，관찰병비교각조환자적위수술기삼수、림상료효급영상학검사지표。결과여결론：Quadrant통도내고정조、경피Sextant내고정조재술중출혈량、수술절구장도、주원시간방면균우우상규후로개방내고정조(P <0.05)。94례환자균획득수방，수방시간위6개월，무탈정、단정급신경손상현상。3조상추내고정후추체전연고도、Cobbs각、시상위지수여내고정전상비교균유명현개선(P<0.05)，단3조지간비교차이무현저성의의(P >0.05)。량미창조내고정후목측류비평분、Oswestry공능장애지수균우우상규개방내고정조(P<0.05)。제시여전통적개방내고정상비，미창(경피Sextant내고정급이용Quadrant통도내고정)치료흉요추골절불부능취득여지상당적영상학효과，이차구유창상소、출혈소、회복쾌、안전성고적우점，유경호적림상료효。재엄격장악수술괄응증정황하，미창방법시치료무신경손상흉요추골절적이상선택。
BACKGROUND:Recently, minimal y invasive techniques obtained more attention. Some new minimal y invasive methods have been used in the treatment of spine fracture and provide new chal enges for conventional open surgery. OBJECTIVE:To discuss the clinical efficacy of conventional posterior open pedicle screw fixation versus minimal y invasive operation (using Mast Quadrant System and Sextant percutaneous pedicle screw fixation) for treating single-segment thoracolumbar fractures without neurological damages. METHODS:A total of 94 cases of single-segment thoracolumbar fracture without neurological damages, who were treated in Department of Spine Surgery, Liuzhou Worker’s Hospital in China from January 2012 to January 2013, were enrol ed in this study. According to patients’ conditions and wil ing, they were divided into open fixation group, Quadrant fixation group and percutaneous Sextant fixation group. Perioperative index, clinical efficacy, and imaging results were observed and compared among different groups. RESULTS AND CONCLUSION:Intraoperative blood loss, incision length and length of stay were better in the Quadrant fixation group and percutaneous Sextant fixation group than in the posterior open fixation group (P<0.05). A total of 94 patients were fol owed up for 6 months. No cases of nerve damage, slippage or breakage of implants were found. The anterior vertebral body height, Cobb’s angle, and sagittal index were significantly improved postoperatively compared to pre-operation in al three groups (P<0.05), but there was no significant difference in the three groups (P>0.05). Postoperative Visual Analog Scale scores and Oswestry Disability Index were better in the two minimal y invasive groups than in the conventional open fixation group (P<0.05). These results suggested that compared with conventional open operation, minimal y invasive operation (Mast Quadrant System and Sextant percutaneous pedicle screw fixation) in the treatment of thoracolumbar fractures not only can achieve similar imaging result, but has smal incision, less blood loss, quick recovery, high safety, and obtains good clinical therapeutic outcomes. In the case of strict surgical indications, minimal y invasive method is an ideal choice in treating thoracolumbar fractures without neurological damages.