CAJ | 학술논문

目的探讨后路短节段固定非融合方式治疗严重胸腰椎爆裂骨折的临床疗效,评估其术后影像学和功能恢复情况. 方法选择2011年7月-2013年3月收治的38例严重胸腰椎单节段爆裂骨折患者进行回顾性分析.手术方式采用后路短节段椎弓根螺钉撑开复位内固定联合伤椎置钉和硫酸钙骨水泥强化,无须后外侧植骨融合.术前、术后摄X线及CT片,测量局部后凸Cobb角、伤椎前柱高度及椎管占位.评估术前、术后及随访时患者视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI). 结果所有患者获得随访平均14个月(3～ 20个月).局部后凸Cobb角术前为(21.2±4.3)°,术后即刻为(3.5±1.8)°,末期随访时为(4.8±2.7)°.术前、术后即刻及末期随访时伤椎前缘相对高度分别为(54.8±l4.6)％、(91.7±8.0)％、(87.2±6.0)％.椎管占位术前为(48.0±4.5)％,术后为(23.8±7.8)％,末期随访时为(8.8±4.6)％.末期随访时,6例美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级C级患者中,2例改善至D级,4例改善至E级；10例D级患者均改善至E级；22例E级患者无变化.末期随访时ODI为15.5 ±8.8,VAS为(2.3±0.8)分,较术前均明显改善(P＜0.01).随访期间无内固定并发症发生. 结论后路短节段固定非融合方式能有效恢复脊柱矢状序列和伤椎椎体高度,是治疗胸腰椎爆裂骨折的最有效方法之一.
목적 탐토후로단절단고정비융합방식치료엄중흉요추폭렬골절적림상료효,평고기술후영상학화공능회복정황. 방법 선택2011년7월-2013년3월수치적38례엄중흉요추단절단폭렬골절환자진행회고성분석.수술방식채용후로단절단추궁근라정탱개복위내고정연합상추치정화류산개골수니강화,무수후외측식골융합.술전、술후섭X선급CT편,측량국부후철Cobb각、상추전주고도급추관점위.평고술전、술후급수방시환자시각모의평분(visual analogue scale,VAS)화Oswestry공능장애지수(Oswestry disability index,ODI). 결과 소유환자획득수방평균14개월(3～ 20개월).국부후철Cobb각술전위(21.2±4.3)°,술후즉각위(3.5±1.8)°,말기수방시위(4.8±2.7)°.술전、술후즉각급말기수방시상추전연상대고도분별위(54.8±l4.6)％、(91.7±8.0)％、(87.2±6.0)％.추관점위술전위(48.0±4.5)％,술후위(23.8±7.8)％,말기수방시위(8.8±4.6)％.말기수방시,6례미국척수손상협회(American Spinal Injury Association,ASIA)분급C급환자중,2례개선지D급,4례개선지E급；10례D급환자균개선지E급；22례E급환자무변화.말기수방시ODI위15.5 ±8.8,VAS위(2.3±0.8)분,교술전균명현개선(P＜0.01).수방기간무내고정병발증발생. 결론 후로단절단고정비융합방식능유효회복척주시상서렬화상추추체고도,시치료흉요추폭렬골절적최유효방법지일.
Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery.Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively.Operation procedures were posterior short-segment pedicle screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation.In addition,there was no need for posterolateral interbody fusion.X-ray and CT were performed before and after operation to evaluate local kyphotic angle,anterior fractured vertebral body height and canal encroachment.Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before and after operation as well as in follow-up.Results All patients were followed up for average 14 months (range,3-20 months).Local kyphotic angle was (21.2 ±4.3)° before operation,(3.5 ± 1.8)°immediately after operation,and (4.8 ± 2.7) ° in final follow-up.Relative anterior vertebral height was (54.8 ± 14.6)％ before operation,(91.7 ± 8.0)％ after operation,and (87.2 ± 6.0)％ in final follow-up.Mean canal encroachment was (48.0 ± 4.5)％ preoperatively,(23.8 ± 7.8)％postoperatively,and (8.8 ± 4.6) ％ in final follow-up.In final follow-up,six patients with American Spinal Injury Association (ASIA) grade C on admission showed improvement to grade D (n =2) and grade E (n =4) ; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes.ODI and VAS scored 15.5 ±8.8 and 2.3 ±0.8 in final follow-up with substantial improvement from those before operation (P ＜ 0.01).Complications from internal fixation were not found during follow-up.Conclusion Posterior short-segment fixation without fusion is one of the foremost effective methods for severe thoracolumbar burst fractures,for it can effectively restore the sagittal spinal alignment and the fractured vertebral body height.