CAJ | 학술논문

目的探讨经伤椎置钉技术治疗伴有前、后纵韧带及椎间盘破裂的严重胸腰椎C型骨折的可行性和有效性.方法回顾性分析2008年1月至2012年4月收治的16例伴有前、后纵韧带及椎间盘破裂的胸腰椎C型骨折患者资料,男14例,女2例;年龄21～65岁,平均35.1岁.评估经伤椎置钉技术治疗后的脊柱序列复位、伤椎骨折复位程度,比较术前、术后即刻、术后1年胸腰椎的视觉模拟评分(VAS)和影像学结果.结果 16例患者术后获平均27.8个月的随访,手术时间平均为241.3 min,术中出血量平均为472.8 mL,术后引流血量平均为271.8 mL,住院时间平均为13.3d.经伤椎置钉后脊柱序列复位更完全,术前、术后即刻、术后1年腰背痛VAS评分分别为(7.8±3.1)、(3.2±2.2)、(1.8±1.2)分,伤椎前缘丢失率分别为31.8％±6.9％、8.2％±3.2％、9.1％±3.3％,伤椎前后滑脱率分别为21.9％±5.1％、7.1％±3.8％、5.2％±3.8％,矢状位cobb角分别为25.2°±5.3°、5.3°±3.9°、7.9°±2.8°,伤椎椎管占位率分别为37.8％±6.8％、9.3％±3.5％、8.1％±2.8％.以上指标术后即刻和术后1年均较术前明显改善,差异有统计学意义(P＜0.05),但术后即刻与术后1年比较差异均无统计学意义(P＞0.05).结论合并前、后纵韧带断裂及椎间盘破裂的严重胸腰椎C型骨折伤情特殊,经伤椎置钉技术有助于提高脊柱序列的复位质量和增加后路系统的力学稳定性.
목적 탐토경상추치정기술치료반유전、후종인대급추간반파렬적엄중흉요추C형골절적가행성화유효성.방법 회고성분석2008년1월지2012년4월수치적16례반유전、후종인대급추간반파렬적흉요추C형골절환자자료,남14례,녀2례;년령21～65세,평균35.1세.평고경상추치정기술치료후적척주서렬복위、상추골절복위정도,비교술전、술후즉각、술후1년흉요추적시각모의평분(VAS)화영상학결과.결과 16례환자술후획평균27.8개월적수방,수술시간평균위241.3 min,술중출혈량평균위472.8 mL,술후인류혈량평균위271.8 mL,주원시간평균위13.3d.경상추치정후척주서렬복위경완전,술전、술후즉각、술후1년요배통VAS평분분별위(7.8±3.1)、(3.2±2.2)、(1.8±1.2)분,상추전연주실솔분별위31.8％±6.9％、8.2％±3.2％、9.1％±3.3％,상추전후활탈솔분별위21.9％±5.1％、7.1％±3.8％、5.2％±3.8％,시상위cobb각분별위25.2°±5.3°、5.3°±3.9°、7.9°±2.8°,상추추관점위솔분별위37.8％±6.8％、9.3％±3.5％、8.1％±2.8％.이상지표술후즉각화술후1년균교술전명현개선,차이유통계학의의(P＜0.05),단술후즉각여술후1년비교차이균무통계학의의(P＞0.05).결론 합병전、후종인대단렬급추간반파렬적엄중흉요추C형골절상정특수,경상추치정기술유조우제고척주서렬적복위질량화증가후로계통적역학은정성.
Objective To report our experience of using direct reduction and fixation through the pedicle of fractured vertebra to treat thoracolumbar fractures of Margerl type C which were complicated with ruptures of longitudinal ligaments and intervertebral discs.Methods From January 2008 to April 2012,16 patients with thoracolumbar fracture of Margerl type C and concomitant ruptures of longitudinal ligaments and intervertebral discs were treated with intermediate fixation with one or two additional screws in the fractured vertebra.They were 14 men and 2 women,aged from 21 to 65 years (average,35.1 years).The visual analogue scale (VAS) and radiological results were compared at preoperation,immediate postoperation and one year postoperation in all patients.The surgical outcomes were analyzed in terms of kyphosis angle,anterior height compression rate,dislocation,the radius vector of the spinal canal,and Frankel classification.Results All patients were followed up for an average of 27.8 months.The operation time averaged 241.3 minutes,intraoperative blood loss 472.8 mL,postoperative blood drainage 271.8 mL and hospital stay 13.3 days.The VAS for back pain at preoperation,immediate postoperation and one year postoperation was respectively 7.8 ±3.1,3.2 ±2.2,and 1.8 ± 1.2; the anterior height loss of the fractured vertebra was respectively 31.8％ ±6.9％,8.2％ ±3.2％,and 9.1％ ±3.3％.Fixation through the pedicle of fractured vertebra resulted in more complete reduction of the spinal sequence.The spondylolisthesis rate of the fractured vertebra was respectively 21.9％ ± 5.1％,7.1％ ± 3.8％ and 5.2％ ± 3.8％ ; the sagittal cob angle of the fractured vertebra was respectively 25.2° ± 5.3°,5.3° ± 3.9° and 7.9° ± 2.8°; the sagittal canal occupation rate of the fractured vertebra was respectively 37.8％ ±6.8％,9.3％ ±3.5％ and 8.1％ ±2.8％.There were significant improvements in all the above indexes between preoperation and 2 time points postoperation (P ＜ 0.05) but no significant differences between immediate postoperation and one year postoperation (P ＞ 0.05).Conclusion In the treatment of thoracolumbar fractures of Margerl type C with complicated raptures of longitudinal ligaments and intervertebral discs,screw fixation through the pedicle of fractured vertebra helps enhance the reduction of spinal sequence and the mechanical stability of the posterior system.