CAJ | 학술논문

目的探讨后路固定融合治疗胸腰椎完全性骨折脱位的方法与疗效. 方法选择2006年1月-2012年12月收治8例胸腰椎完全性骨折脱位患者,其中男7例,女1例；平均年龄31.9岁(19 ～49岁).受伤至手术时间平均8.1 d(4～12 d).骨折脱位分型:AO分型为C型,Denis分类为三柱损伤,Meyerding创伤性滑脱Ⅴ级的骨折脱位.脊髓神经损伤采用美国脊柱损伤协会(American Spinal Injury Association,ASIA)分级:A级5例,B级1例,C级1例,E级1例.骨折脱位节段:T5～T6 1例,T12 ～L13例,L1～L2 2例,L3 ～L4 1例,L4～L5 1例.所有患者均采用后路椎弓根钉棒系统进行固定融合. 结果平均手术时间220.6 min(135 ～335m in),术中平均出血量1 150 ml(500 ～2 400 ml),7例术中发现有硬膜撕裂,予以缝合硬膜或自体脂肪片覆盖修补,其中3例术后发生脑脊液漏,经保守治疗后治愈.6例获得解剖复位,1例部分复位,1例未行复位.后凸Cobb角由术前平均29.3°(8°～51°)恢复至术后1.9°(-5°～10°).平均随访39.3个月(2～76个月),末次随访时2例分别由术前ASIA分级A/B恢复至C级,余6例患者(A级4例,C级1例,E级1例)无明显变化.所有患者随访期间未发现钉棒断裂松动等内固定相关并发症.1例于术后4年死于肺部相关并发症,1例术后3周出现腰椎深部感染,采用保留内置物的清创冲洗引流处理方法. 结论后路固定融合是胸腰椎完全性骨折脱位总的治疗原则,复位情况的把握取决于脊髓损伤的严重程度.
목적 탐토후로고정융합치료흉요추완전성골절탈위적방법여료효. 방법 선택2006년1월-2012년12월수치8례흉요추완전성골절탈위환자,기중남7례,녀1례；평균년령31.9세(19 ～49세).수상지수술시간평균8.1 d(4～12 d).골절탈위분형:AO분형위C형,Denis분류위삼주손상,Meyerding창상성활탈Ⅴ급적골절탈위.척수신경손상채용미국척주손상협회(American Spinal Injury Association,ASIA)분급:A급5례,B급1례,C급1례,E급1례.골절탈위절단:T5～T6 1례,T12 ～L13례,L1～L2 2례,L3 ～L4 1례,L4～L5 1례.소유환자균채용후로추궁근정봉계통진행고정융합. 결과 평균수술시간220.6 min(135 ～335m in),술중평균출혈량1 150 ml(500 ～2 400 ml),7례술중발현유경막시렬,여이봉합경막혹자체지방편복개수보,기중3례술후발생뇌척액루,경보수치료후치유.6례획득해부복위,1례부분복위,1례미행복위.후철Cobb각유술전평균29.3°(8°～51°)회복지술후1.9°(-5°～10°).평균수방39.3개월(2～76개월),말차수방시2례분별유술전ASIA분급A/B회복지C급,여6례환자(A급4례,C급1례,E급1례)무명현변화.소유환자수방기간미발현정봉단렬송동등내고정상관병발증.1례우술후4년사우폐부상관병발증,1례술후3주출현요추심부감염,채용보류내치물적청창충세인류처리방법. 결론 후로고정융합시흉요추완전성골절탈위총적치료원칙,복위정황적파악취결우척수손상적엄중정도.
Objective To investigate the methods and effects of posterior fixation and fusion in treatment of complete thoracolumbar fracture and dislocation.Methods The study enrolled 8 cases of complete thoracolumbar fracture and dislocation treated by posterior fixation and fusion with pedicle screwrod system between January 2006 and December 2012.There were 7 males and 1 female,at mean age of 31.9 years (range,19-49 years).Mean time interval between injury and surgery was 8.1 days (range,4-12 days).Fracture-dislocation classification was AO type C,Denis three-column injury,and Meyerding grade V.According to American Spinal Injury Association (ASIA),there 5 cases at grades A,1 at grade B,1 at grade C 1 at grade E.Fracture-dislocation segments included T5-T6 in 1 case,T12-L1 in 3,L1-L2 in 2,L3-L4 in 1 and L4-L5 in 1.Results Mean duration of surgery was 220.6 minutes (range,135-335 minutes) and mean intraoperative blood loss was 1 150 ml (range,500-2 400 ml).Seven cases sustained dural laceration during the operation,which were sutured or covered with autologous fat grafts,but 3 of them were subjected to cerebrospinal fluid leakage and healed after conservative therapy.Anatomic reduction was achieved in 6 cases,partial reduction in 1 and non-reduction in 1.Mean Cobb angle improved from 29.3 ° (range,8 °-51 °) preoperatively to 1.9 ° (range,-5°-10 °) postoperatively.After a mean follow-up of 39.3 months (range,2-76 months),2 cases were recovered from preoperative ASIA grade A and B to C respectively and 6 cases (4 A,1 C,1 E) revealed no significant improvement.There was no implant loosening or breakage.One case was died of lung-related complications at postoperative 4 years.One case sustained lumbar deep infection at postoperative 3 weeks and managed by debridement,irrigation,drainage and implant retention.Conclusion Posterior fixation and fusion is the general treatment principle for complete thoracolumbar fracture and dislocation,but the degree of reduction depends on severity of the injured spinal cord.