CAJ | 학술논문

背景：随着微创理念在外科临床中的不断深入发展和微创技术的发展，经皮外科技术及经通道外科技术越来越被更多的应用于临床。目的：探讨经皮微创与常规切开椎弓根螺钉内固定治疗不稳定性胸腰椎骨折的临床疗效。方法：2012年7月至2013年6月收治不稳定性胸腰椎骨折患者32例，均为单节段椎体骨折，均未合并其他骨折和脏器损伤、脊髓或神经根损伤。32例患者随机分为2组，16例采用经皮微创椎弓根螺钉内固定（实验组）；16例采用常规切开椎弓根螺钉内固定（对照组）。比较两组患者的手术时间、术中及术后出血量、住院天数、术后切口愈合情况及并发症；比较两组患者术后1、3、6个月的疼痛评分（VAS）；比较两组患者术前、术后1个月、术后3个月、术后6个月的椎体前缘影像学高度及后凸Cobb角的改善情况。结果：所有患者均未出现神经损伤、术后感染、内固定松动、内固定断裂等并发症。两组患者的手术时间无统计学差异；术中及术后出血量、住院天数有统计学差异（P＜0.05）。实验组与对照组患者的术后椎体前缘影像学高度及后凸Cobb角均较术前有明显改善，组间比较无统计学差异。对照组1例患者术后出现椎旁肌内血肿形成经穿刺抽吸，切口局部加压后甲级愈合。结论：经皮微创椎弓根螺钉内固定技术符合微创原则，是治疗单节段无神经损伤胸腰段骨折的有效方法。
배경：수착미창이념재외과림상중적불단심입발전화미창기술적발전，경피외과기술급경통도외과기술월래월피경다적응용우림상。목적：탐토경피미창여상규절개추궁근라정내고정치료불은정성흉요추골절적림상료효。방법：2012년7월지2013년6월수치불은정성흉요추골절환자32례，균위단절단추체골절，균미합병기타골절화장기손상、척수혹신경근손상。32례환자수궤분위2조，16례채용경피미창추궁근라정내고정（실험조）；16례채용상규절개추궁근라정내고정（대조조）。비교량조환자적수술시간、술중급술후출혈량、주원천수、술후절구유합정황급병발증；비교량조환자술후1、3、6개월적동통평분（VAS）；비교량조환자술전、술후1개월、술후3개월、술후6개월적추체전연영상학고도급후철Cobb각적개선정황。결과：소유환자균미출현신경손상、술후감염、내고정송동、내고정단렬등병발증。량조환자적수술시간무통계학차이；술중급술후출혈량、주원천수유통계학차이（P＜0.05）。실험조여대조조환자적술후추체전연영상학고도급후철Cobb각균교술전유명현개선，조간비교무통계학차이。대조조1례환자술후출현추방기내혈종형성경천자추흡，절구국부가압후갑급유합。결론：경피미창추궁근라정내고정기술부합미창원칙，시치료단절단무신경손상흉요단골절적유효방법。
Background:With the development of minimally invasive technique in clinical, the percutaneous surgical technology and the surgical techniques by channel have been widely used. Objective:To explore the clinical effects of percutaneous and conventional pedicle screw fixation for the treatment of unsta-ble thoracolumbar vertebral compression fractures. Methods:From July 2012 to June 2013, 32 patients with single-segment unstable thoracolumbar fractures were randomly di-vided into 2 groups (n=16). Percutaneous pedicle screw was implanted in experimental group and conventional pedicle screw was implanted in control group. The perioperative data such as operative time, blood loss volume, complications, postoperative incision and fracture healing were compared between groups. VAS score 1, 3 and 6 months after surgery and vertebral height and Cobb angle before surgery and 1, 3 and 6 months after surgery were evaluated. Results: No patients suffered from nerve injury, postoperative infection, internal fixation loosening or breakage or other complications. Radiographic vertebral height and kyphosis Cobb angle are recovered obviously after surgery, but there were no significant differences between groups. Neither was the operation time. There were significant differences in blood loss and hospital stay between groups (P<0.05). In the control group, postoperative paraspinal muscle hematoma was found and treated by puncture and aspiration. Conclusions:Minimally invasive percutaneous pedicle screw fixation technology matches the minimally invasive principle. It is an effective method for the single segment thoracolumbar fractures without neurological injury.