CAJ | 학술논문

目的探讨经椎间孔腰椎椎体间融合术(TLIF)在胸腰段爆裂性骨折手术中的作用.方法 2010年1月至2012年1月应用TLIF技术治疗椎体前缘高度丢失大于50％,椎管占位率大于40％的胸腰段单节段爆裂性骨折患者共23例,男15例,女8例；年龄22～61岁,平均45.3岁；损伤节段:T12 5例,L115例,L23例.骨折按照Denis分型:均为爆裂性骨折.脊髓神经功能受损情况按美国脊髓损伤协会(ASIA)脊髓神经功能障碍分级:A级1例,B级2例,C级7例,D级11例,E级2例.结果本组患者手术时间100～160 min,平均140 min；出血量200～750 mL,平均370 mL.无术中、术后并发症发生.术后随访5 ～ 24个月(平均12.3个月),末次随访时脊髓神经功能按ASIA分级:A级1例,B级1例,C级4例,D级7例,E级10例,平均提高1.8级.伤椎前缘高度由术前45.2％±17.6％恢复至术后90.2％±13.7％,后缘高度由术前81.5％±14.3％恢复至术后93.5％±15.4％,cobb角由术前28.4°±11.8°改善至术后6.4°±3.8°,以上指标差异均有统计学意义(P＜0.05).结论 TLIF技术可用于胸腰段爆裂性骨折的治疗,能完成对骨折的减压、固定和前柱的支撑植骨融合,值得推广应用.
목적 탐토경추간공요추추체간융합술(TLIF)재흉요단폭렬성골절수술중적작용.방법 2010년1월지2012년1월응용TLIF기술치료추체전연고도주실대우50％,추관점위솔대우40％적흉요단단절단폭렬성골절환자공23례,남15례,녀8례；년령22～61세,평균45.3세；손상절단:T12 5례,L115례,L23례.골절안조Denis분형:균위폭렬성골절.척수신경공능수손정황안미국척수손상협회(ASIA)척수신경공능장애분급:A급1례,B급2례,C급7례,D급11례,E급2례.결과 본조환자수술시간100～160 min,평균140 min；출혈량200～750 mL,평균370 mL.무술중、술후병발증발생.술후수방5 ～ 24개월(평균12.3개월),말차수방시척수신경공능안ASIA분급:A급1례,B급1례,C급4례,D급7례,E급10례,평균제고1.8급.상추전연고도유술전45.2％±17.6％회복지술후90.2％±13.7％,후연고도유술전81.5％±14.3％회복지술후93.5％±15.4％,cobb각유술전28.4°±11.8°개선지술후6.4°±3.8°,이상지표차이균유통계학의의(P＜0.05).결론 TLIF기술가용우흉요단폭렬성골절적치료,능완성대골절적감압、고정화전주적지탱식골융합,치득추엄응용.
Objective To evaluate the effects of transforaminal lumbar interbody fusion (TLIF) in the treatment of thoracolumbar burst fractures.Methods From January 2010 to January 2012,we performed TLIF for 23 patients with burst fracture of single thoracolumbar segment whose loss of anterior border height of the injured vertebra was over 50％ and over 40％ of whose spinal canal was occupied.They were 15 men and 8 women,22 to 61 years of age,averaging 45.3 years.The fractures happened at T12 in 5 cases,at L1 in 15 and at L2 in 3.By Denis classification,all of them were burst fracture.By the American Spinal Injury Association (ASIA) grading system,the neural function was rated as grade A in 1 cases,as grade B in 2,as grade C in 7,as grade D in 11 and as grade E in 2.Results The operation time ranged from 100 to 160 minutes,averaging 140 minutes; the bleeding volume ranged from 200 to 750 mL,averaging 370 mL.There were no inter-or post-operative complications.They were followed for 5 to 24 months,averaging 12.3 months.By the ASIA grading of their neural functional recovery at the last follow-up,one case was rated as grade A,1 cases as grade B,4 as grade C,7 as grade D and l0 as grade E,with an average improvement of 1.8 ASIA grades.The mean anterior border height of the injured vertebra recovered from 45.2％ ± 17.6％ of the normal height preoperation to 90.2％ ± 13.7％ postoperation; the mean posterior border height recovered from preoperative 81.5％ ± 14.3％ to postoperative 93.5％ ± 15.4％ ; the mean cobb angle decreased from preoperative 28.4° ± 11.8° to postoperative 6.4° ± 3.8°.The differences between preoperation and postoperation were significant (P ＜ 0.05).Conclusion In the treatment of thoracolumbar burst fractures,TLIF technique should be recommended because it can be used to complete decompression and internal fixation of the fracture and strut fusion of the anterior column simultaneously through a single posterior approach.