CAJ | 학술논문

目的：探讨一期后路 USS 系统长节段固定加后外侧植骨融合治疗强直性脊柱炎胸腰椎骨折脱位的疗效。方法2011年1月至2012年7月我科收治17例强直性脊柱炎胸腰椎骨折脱位的患者，经临床症状结合外伤史及影像学检查确诊，其中9例患者合并不同程度的脊髓损害，采用一期后路 USS 钉棒系统长节段固定加植骨融合治疗方法治疗，观察患者疼痛视觉模拟评分（visual analogue scale，VAS）、神经功能恢复及临床骨愈合情况，评价治疗效果，并记录手术时间、术中出血量及手术并发症。结果手术时间为160~250 min，术中失血量300~700 mL。随访3~6个月（平均4.5个月），所有患者疼痛较术前明显缓解。围手术期无死亡病例，未发生伤口感染，并发肺炎2例，8例神经损伤患者，神经系统功能有不同程度恢复。所有患者骨折部位均达到临床骨性愈合，脊柱序列稳定，随访期内未发生钉棒断裂、松动等并发症。结论采用 USS 钉棒系统长节段固定加后外侧植骨融合方式可有效提高强直性脊柱炎胸腰椎骨折脱位固定的可靠性及稳定性，提高植骨融合率，明显缓解患者疼痛，并可不同程度改善患者神经损伤功能。
목적：탐토일기후로 USS 계통장절단고정가후외측식골융합치료강직성척주염흉요추골절탈위적료효。방법2011년1월지2012년7월아과수치17례강직성척주염흉요추골절탈위적환자，경림상증상결합외상사급영상학검사학진，기중9례환자합병불동정도적척수손해，채용일기후로 USS 정봉계통장절단고정가식골융합치료방법치료，관찰환자동통시각모의평분（visual analogue scale，VAS）、신경공능회복급림상골유합정황，평개치료효과，병기록수술시간、술중출혈량급수술병발증。결과수술시간위160~250 min，술중실혈량300~700 mL。수방3~6개월（평균4.5개월），소유환자동통교술전명현완해。위수술기무사망병례，미발생상구감염，병발폐염2례，8례신경손상환자，신경계통공능유불동정도회복。소유환자골절부위균체도림상골성유합，척주서렬은정，수방기내미발생정봉단렬、송동등병발증。결론채용 USS 정봉계통장절단고정가후외측식골융합방식가유효제고강직성척주염흉요추골절탈위고정적가고성급은정성，제고식골융합솔，명현완해환자동통，병가불동정도개선환자신경손상공능。
Objective To investigate the effects of posterior long segmental fixation used USS system and bone graft in the treatment of thoracolumbar vertebral fracture and dislocation patients with ankylosing spondylitis. Methods Form January 2011 to July 2012,17 ankylosing spondylitis cases with thoracolumbar vertebral fracture and dislocation were confirmed by clinical symptoms,images(X-ray and CT,MRI)in our department of,all patients had a history of trauma. 9 patients had var-ying degrees of neurological dysfunction. All patients accepted surgical treatment with posterior long segmental fixation used USS system and bone graft. The operation time,blood lose and postoperative complications was recorded in this study. The clin-ical outcomes were evaluated by VSA scores,neurological function recovery and clinical bone fusion. Results The operation time was 160 ~ 250 min,the blood loss was 300 ~ 700 mL. All of the patients were followed up for 3 ~ 6 months(mean 4. 5 months),and the symptom of thoracolumbar pain significantly were relieved,there was no incision infection and patient die,2 patients had pneumonia during perioperative. 8 cases of which had neurological dysfunction got different degrees of improve-ment after the operation. Clinical evidence of bone fusion was observed in all of the 17 patients. There were no loosening and breakage of internal fixation in the later followed up. Conclusion Posterior long segmental fixation used USS system and bone graft can effectively improve the reliability and stability of the fixation in AS patients with thoracolumbar vertebral fracture and dislocation. It can reduce pain and increase the probability of bone fusion in AS patients significantly,and also it can improve the patients' neurological dysfunction.