CAJ | 학술논문

目的：探究经伤椎椎弓根复位固定的对于治疗胸腰椎骨折的可行性及其临床疗效。方法根据随机数字表法将60例单椎体胸腰椎骨折患者分为30例的经伤椎椎弓根固定的6钉固定术(6钉组)和30例的单纯行跨伤椎的4钉固定术(4钉组),对所有的患者随访12~43个月,平均随访(27.65±2.42)个月,通过比较两组的手术时间、术中出血量、术后卧床时间、术后伤口引流量等从而得到围手术期指标及伤椎前后缘高度比值内固定失败率腰背痛评分改善指数及神经功能恢复情况。结果两组围手术期相关指标中术中出血量、手术时间、术后卧床时间比较,差异有统计学意义(P<0.05),4钉组过度撑开致术后螺钉松动率为13.33%,后凸加重发生率为10.00%,这是4钉组的情况,但是6钉组则不存在此情况。4钉组术后1周和术后6个月随访腰背痛评分平均改善率均低于6钉组,差异有统计学意义,但两组术后神经功能恢复情况具有较大的差异无统计学意义。结论经伤椎椎弓根置钉能更直接牢固骨折和固定复位,改善应力分布和固定的强度,比传统跨伤椎固定能更好的维持矫正效果。
목적：탐구경상추추궁근복위고정적대우치료흉요추골절적가행성급기림상료효。방법근거수궤수자표법장60례단추체흉요추골절환자분위30례적경상추추궁근고정적6정고정술(6정조)화30례적단순행과상추적4정고정술(4정조),대소유적환자수방12~43개월,평균수방(27.65±2.42)개월,통과비교량조적수술시간、술중출혈량、술후와상시간、술후상구인류량등종이득도위수술기지표급상추전후연고도비치내고정실패솔요배통평분개선지수급신경공능회복정황。결과량조위수술기상관지표중술중출혈량、수술시간、술후와상시간비교,차이유통계학의의(P<0.05),4정조과도탱개치술후라정송동솔위13.33%,후철가중발생솔위10.00%,저시4정조적정황,단시6정조칙불존재차정황。4정조술후1주화술후6개월수방요배통평분평균개선솔균저우6정조,차이유통계학의의,단량조술후신경공능회복정황구유교대적차이무통계학의의。결론경상추추궁근치정능경직접뢰고골절화고정복위,개선응력분포화고정적강도,비전통과상추고정능경호적유지교정효과。
Objective The feasibility and clinical curative effect of treating thoracolumbar vertebral fracture through resetting and fixing of injured vertebral pedicle are discussed in the thesis. Methods 60 patients with single-vertebral thoracolumbar fracture are divided into two groups according to the random number table method;the first group has 30 patients who are subjected to 6-nail fixation of injured vertebral pedicle fixation (6-nail group);the second group has 30 patients who are subjected to 4-nail fixa-tion of simple line-cross injured vertebra (4-nail group). The follow-up visit time of all patients is 12 to 43 months; the average time is (27.65±2.42) months. Perioperative indicators such as operation time, the amount of intraoperative blood loss, postoperative bedrest time, postoperative wound drainage, and front and rear edge height ratios of injured vertebrae, the internal fixation failure rate, lumbago and backache score improvement ratio, and neural functional recovery conditions of the two groups are compared profoundly and carefully. Results The differences in intraoperative indicators such as the amount of intraoperative blood loss, oper-ation time and postoperative bedrest time between the two groups are statistically significant (P<0.05). Postoperative screw loosen-ing rate caused by excessive opening in the 4-nail group is 13.33%; the kyphosis exacerbation occurrence rate is 10.00%; while the condition does not happen in the 6-nail group. Moreover, lumbago and backache score average improvement ratio in the fol-low-up visit after the operation conducted for 1 week and 6 months in 6-nail group is higher than that in 4-nail group, which has statistical significance. However, the comparative difference of postoperative nervous function recovery conditions in two groups has no statistical significance. Conclusion Injured vertebral pedicle nail can fix fractures and reset them more firmly and directly, im-prove the stress distribution and fixation strength, and the correction effect can be maintained better than that of the traditional cross-injured-vertebrae fixation.