CAJ | 학술논문

背景：经伤椎椎弓根钉内固定术治疗单节段胸腰椎爆裂性骨折可增加脊柱的生物力学稳定性，明显降低术后内固定失败、伤椎椎体高度矫正丢失等并发症的发生率，但传统开放手术需广泛剥离椎旁肌止点，创伤大、出血多、恢复慢。 　　目的：评估经伤椎微创椎弓根钉内固定术（微小切口非空心椎弓根钉技术）治疗胸腰椎爆裂性骨折的疗效。 　　方法：2011年4月至2011年9月行经伤椎微创椎弓根钉内固定术治疗20例单节段胸腰椎新鲜爆裂性骨折且无神经症状的患者，男12例，女8例；年龄41~60岁，平均（50.3±5.5）岁，伤椎位于T11~L2，均属A3型骨折。记录手术时间、术中出血量和住院天数，观察并记录术前、术后即刻、术后1个月、术后2个月、术后个3月、术后6个月、术后1年、术后2年的腰背痛VAS评分，比较术前及术后各时间点的VAS评分、椎体高度压缩率、后凸角及术后各时间点的椎体高度恢复率、后凸矫正率。 　　结果：手术时间为80~110 min，平均（90±9）min；出血量为40~95 ml，平均（68±17）ml；住院时间5~8 d，平均（6.7±1.2）d。20例全部获得随访，随访时间为24~29个月，平均（26±2）个月。VAS评分由术前（8.5±1.1）分明显下降至术后即刻（1.9±0.6）分（P＜0.001）及2年随访时（0.4±0.5）分（P＜0.001）；椎体高度压缩率由术前（49.3±7.4）%显著下降至术后即刻（5.2±1.6）%（P＜0.001）及2年随访时（7.0±1.5）%（P＜0.001）；后凸角由术前22.0°±1.9°下降至术后即刻3.1°±1.8°（P＜0.001）及2年随访时6.1°±1.4°（P＜0.001）。术后随访过程中椎体高度恢复率、后凸矫正率无明显减小。无一例出现螺钉松动、断钉及断棒。 　　结论：经伤椎微创椎弓根钉内固定术是治疗胸腰椎爆裂性骨折安全而有效的方法，并应严格掌握其手术适应证。揹景：經傷椎椎弓根釘內固定術治療單節段胸腰椎爆裂性骨摺可增加脊柱的生物力學穩定性，明顯降低術後內固定失敗、傷椎椎體高度矯正丟失等併髮癥的髮生率，但傳統開放手術需廣汎剝離椎徬肌止點，創傷大、齣血多、恢複慢。 　　目的：評估經傷椎微創椎弓根釘內固定術（微小切口非空心椎弓根釘技術）治療胸腰椎爆裂性骨摺的療效。 　　方法：2011年4月至2011年9月行經傷椎微創椎弓根釘內固定術治療20例單節段胸腰椎新鮮爆裂性骨摺且無神經癥狀的患者，男12例，女8例；年齡41~60歲，平均（50.3±5.5）歲，傷椎位于T11~L2，均屬A3型骨摺。記錄手術時間、術中齣血量和住院天數，觀察併記錄術前、術後即刻、術後1箇月、術後2箇月、術後箇3月、術後6箇月、術後1年、術後2年的腰揹痛VAS評分，比較術前及術後各時間點的VAS評分、椎體高度壓縮率、後凸角及術後各時間點的椎體高度恢複率、後凸矯正率。 　　結果：手術時間為80~110 min，平均（90±9）min；齣血量為40~95 ml，平均（68±17）ml；住院時間5~8 d，平均（6.7±1.2）d。20例全部穫得隨訪，隨訪時間為24~29箇月，平均（26±2）箇月。VAS評分由術前（8.5±1.1）分明顯下降至術後即刻（1.9±0.6）分（P＜0.001）及2年隨訪時（0.4±0.5）分（P＜0.001）；椎體高度壓縮率由術前（49.3±7.4）%顯著下降至術後即刻（5.2±1.6）%（P＜0.001）及2年隨訪時（7.0±1.5）%（P＜0.001）；後凸角由術前22.0°±1.9°下降至術後即刻3.1°±1.8°（P＜0.001）及2年隨訪時6.1°±1.4°（P＜0.001）。術後隨訪過程中椎體高度恢複率、後凸矯正率無明顯減小。無一例齣現螺釘鬆動、斷釘及斷棒。 　　結論：經傷椎微創椎弓根釘內固定術是治療胸腰椎爆裂性骨摺安全而有效的方法，併應嚴格掌握其手術適應證。
배경：경상추추궁근정내고정술치료단절단흉요추폭렬성골절가증가척주적생물역학은정성，명현강저술후내고정실패、상추추체고도교정주실등병발증적발생솔，단전통개방수술수엄범박리추방기지점，창상대、출혈다、회복만。 　　목적：평고경상추미창추궁근정내고정술（미소절구비공심추궁근정기술）치료흉요추폭렬성골절적료효。 　　방법：2011년4월지2011년9월행경상추미창추궁근정내고정술치료20례단절단흉요추신선폭렬성골절차무신경증상적환자，남12례，녀8례；년령41~60세，평균（50.3±5.5）세，상추위우T11~L2，균속A3형골절。기록수술시간、술중출혈량화주원천수，관찰병기록술전、술후즉각、술후1개월、술후2개월、술후개3월、술후6개월、술후1년、술후2년적요배통VAS평분，비교술전급술후각시간점적VAS평분、추체고도압축솔、후철각급술후각시간점적추체고도회복솔、후철교정솔。 　　결과：수술시간위80~110 min，평균（90±9）min；출혈량위40~95 ml，평균（68±17）ml；주원시간5~8 d，평균（6.7±1.2）d。20례전부획득수방，수방시간위24~29개월，평균（26±2）개월。VAS평분유술전（8.5±1.1）분명현하강지술후즉각（1.9±0.6）분（P＜0.001）급2년수방시（0.4±0.5）분（P＜0.001）；추체고도압축솔유술전（49.3±7.4）%현저하강지술후즉각（5.2±1.6）%（P＜0.001）급2년수방시（7.0±1.5）%（P＜0.001）；후철각유술전22.0°±1.9°하강지술후즉각3.1°±1.8°（P＜0.001）급2년수방시6.1°±1.4°（P＜0.001）。술후수방과정중추체고도회복솔、후철교정솔무명현감소。무일례출현라정송동、단정급단봉。 　　결론：경상추미창추궁근정내고정술시치료흉요추폭렬성골절안전이유효적방법，병응엄격장악기수술괄응증。
Background: Traditional short nonsegmental posterior fixation for thoracolumbar burst fractures often suffers from high rates of failure. Constructive stability may be improved by inserting additional screws at the injured level. But there are more intraoperative blood loss, more postoperative pain and longer hospital stay during open surgery. Objective:To evaluate the feasibility and safety of minimally invasive short-segment posterior fixation at the level of the fracture for treating acute thoracolumbar burst fracture. Methods:Twenty patients who sustained thoracic or lumbar fresh A3 burst fracture without neurologic deficits underwent minimally invasive pedicle screw fixation at the level of fracture and adjacent vertebrae. There were 12 males and 8 females with an average age of (50.3 ± 5.5) years (ranging 41-60 years). The injured vertebrae ranged from T11 to L2. Operation time, intraoperative blood loss and hospital stay were recorded. Visual analog scale (VAS) scores, Cobb angles and anterior vertebral body height were measured before surgery and immediately, 1, 2, 3, 6, 12 and 24 months after surgery. Results:The average operation time was (90±9) min (ranging 80-110 min). Blood loss was (68±17) ml during the procedure (ranging 40-95 ml). The average hospital stay was (6.7 ± 1.2) d (ranging 5-8 d). The duration of follow-up was (26 ± 2) months on average in all the patients (ranging 24-29 months). Compared with the preoperative ones, the VAS scores were significantly decreased immediately and 2 years after surgery (8.5±1.1, 1.9±0.6, 0.4±0.5, P<0.001), the Cobb angles were significantly decreased immediately and 2 years after surgery (22.0° ± 1.9° , 3.1° ± 1.8° , 6.1° ± 1.4° , P<0.001), and the com-pression rate of vertebral body height were also significantly decreased immediately and 2 years after surgery (49.3%±7.4%, 5.2%±1.6%, 7.0%±1.5%, P<0.001). No significant changes in both kyphosis correction and vertebral body height restora-tion were observed during follow-up. There was no patient with the failure of instruments during the follow-up. Conclusions:Minimally invasive short-segment posterior fixation at the level of fracture is a good choice for the treatment of acute thoracolumbar burst fracture.