CAJ | 학술논문

目的：探讨经横突窗椎间孔入路治疗骨折块突入椎管的胸腰椎爆裂性骨折的可行性及临床疗效。方法回顾性分析自2007年9月至2011年3月收治的85例侵入骨块占椎管矢状径比率大于30%胸腰椎爆裂性骨折患者，按胸腰椎损伤严重度评分（ the thoracolumbar injury severity score，TLISS）载荷总评分为4~7分，平均为5.4分；按Frankel分级，A级9例，B级12例，C级19例，D级14例，E级31例。所有病例均采用经横突窗椎间孔入路减压、后外侧植骨融合内固定术式。结果手术均顺利完成，手术时间90~130 min，平均为110 min；术中出血量为150~340 mL，平均220 mL；术后椎体高度恢复满意，成角畸形消失；术后Franke 1分级，A级6例，B级9例，C级16例，D级13例，E级41例，Franke1分级平均提高1~3级；术前术后椎体楔变角、交界性后凸角改变差异有统计学意义（ P<0.05）。结论经横突窗椎间孔入路治疗胸腰椎爆裂性骨折具有入路简单、能同时兼备前路和后路术式的优点，椎管减压彻底，可有效恢复椎管容积和脊柱稳定性，是治疗胸腰椎爆裂骨折的理想新术式。
목적：탐토경횡돌창추간공입로치료골절괴돌입추관적흉요추폭렬성골절적가행성급림상료효。방법회고성분석자2007년9월지2011년3월수치적85례침입골괴점추관시상경비솔대우30%흉요추폭렬성골절환자，안흉요추손상엄중도평분（ the thoracolumbar injury severity score，TLISS）재하총평분위4~7분，평균위5.4분；안Frankel분급，A급9례，B급12례，C급19례，D급14례，E급31례。소유병례균채용경횡돌창추간공입로감압、후외측식골융합내고정술식。결과수술균순리완성，수술시간90~130 min，평균위110 min；술중출혈량위150~340 mL，평균220 mL；술후추체고도회복만의，성각기형소실；술후Franke 1분급，A급6례，B급9례，C급16례，D급13례，E급41례，Franke1분급평균제고1~3급；술전술후추체설변각、교계성후철각개변차이유통계학의의（ P<0.05）。결론경횡돌창추간공입로치료흉요추폭렬성골절구유입로간단、능동시겸비전로화후로술식적우점，추관감압철저，가유효회복추관용적화척주은정성，시치료흉요추폭렬골절적이상신술식。
Objective To investigate the feasibility and efficacy of of thoracolumbar burst fractures with fracture fragments in spinal canal through transforaminal approach in the window of transverse process. Methods A retrospective analysis was carried out for 85 cases of thoracolumbar burst fracture from September 2007 to March 2011,and there were fracture fragments which were more thanl 30% diameter of spinal canal ratio. According to the TLISS,the total score was 4 to 7,averaged 5. 4, and by Frankel grade,9 cases with type A,12 cases with type B,19 cases with type C,14 cases with type D,31 cases with type F. All patients were treated by decompression,posterolateral bone graft fusion,and internal fixation through transforaminal ap-proach in the window of transverse process. Results Operation were successfully completed,the operative time was from 90 to 130 min with an average of 110 min,and the amount of blood loss was from 150 to 340 mL with an average of 220 mL;postop-erative vertebral height recovered satisfactorily,angular deformity disappeared;postoperative Franke classification was improved by an average of 1 to 3,and there were A grade in 6 cases,B grade in 9 cases,C grade in16 cases,D grade in 13 cases,E grade in 4 1 cases;preoperative and postoperative vertebral wedge angle ,junctional kyphosis change had significant difference( P <0. 05). Conclusion The operation through transforaminal approach in the window of transverse process implemented easily, and it also has the advantages of both anterior and posterior operation in treatment of thoracolumbar burst fracture. It is an ideal new option that can fully decompress,effectively restore the volume of vertebral canal and spinal stability.