CAJ | 학술논문

目的比较重度胸腰段爆裂骨折前后路联合和后路经椎弓根伤椎次全切、内固定植骨融合术中长期疗效.方法回顾2007年2月至2009年11月47例重度胸腰段爆裂骨折病例.按手术方式分为两组,A组25例接受前后路联合前路伤椎次全切、后路复位内周钉融合术,B组22例接受后路经椎弓根伤椎次全切、减压和固定手术.收集所有患者临床和影像学资料,所有患者术后3、6、12个月及随后每年1次随访(36 ～ 68个月).记录围手术期失血量、手术时间,手术并发症以及术后1周肺功能；分别记录每次随访时Frankel分级、美国脊柱损伤协会(ASIA)运动功能评分；影像学资料评估椎体前缘高度和Cobb角.结果末次随访,所有患者最终获得坚固融合,神经症状改善显著.B组围手术期失血量、手术时间、术后l周肺功能明显优于A组,分别为(677.4±178.2)ml比(902.4±156.9) ml；(155.1 ±29.7)min比(194.2±35.7) min；肺功能分别为(2.8±0.4)分比(2.3±0.5)分和(2.7±0.3)分比(2.2±0.3)分及(84.2±9.8)分比(74.8±10.5)分,P＜0.05.ASIA运动功能评分以及影像学结果两组在不同随访时间点均差异无统计学意义(均P＞0.05).末次随访,神经功能Frankel分级,A组平均改善约1.4级,B组约1.41级；末次随访Cobb角、伤椎椎体前缘高度较术后略有丢失,但差异无统计学意义(P＞0.05).结论前后联合人路、后路椎体次全切、减压以及内固定均可以有效治疗胸腰段爆裂骨折.但后路手术具备术中出血少、手术时间短和肺功能影响不大等明显优势.
목적 비교중도흉요단폭렬골절전후로연합화후로경추궁근상추차전절、내고정식골융합술중장기료효.방법 회고2007년2월지2009년11월47례중도흉요단폭렬골절병례.안수술방식분위량조,A조25례접수전후로연합전로상추차전절、후로복위내주정융합술,B조22례접수후로경추궁근상추차전절、감압화고정수술.수집소유환자림상화영상학자료,소유환자술후3、6、12개월급수후매년1차수방(36 ～ 68개월).기록위수술기실혈량、수술시간,수술병발증이급술후1주폐공능；분별기록매차수방시Frankel분급、미국척주손상협회(ASIA)운동공능평분；영상학자료평고추체전연고도화Cobb각.결과 말차수방,소유환자최종획득견고융합,신경증상개선현저.B조위수술기실혈량、수술시간、술후l주폐공능명현우우A조,분별위(677.4±178.2)ml비(902.4±156.9) ml；(155.1 ±29.7)min비(194.2±35.7) min；폐공능분별위(2.8±0.4)분비(2.3±0.5)분화(2.7±0.3)분비(2.2±0.3)분급(84.2±9.8)분비(74.8±10.5)분,P＜0.05.ASIA운동공능평분이급영상학결과량조재불동수방시간점균차이무통계학의의(균P＞0.05).말차수방,신경공능Frankel분급,A조평균개선약1.4급,B조약1.41급；말차수방Cobb각、상추추체전연고도교술후략유주실,단차이무통계학의의(P＞0.05).결론 전후연합인로、후로추체차전절、감압이급내고정균가이유효치료흉요단폭렬골절.단후로수술구비술중출혈소、수술시간단화폐공능영향불대등명현우세.
Objective To compare the medium and long-term outcomes of lateral position one-stage plus anteroposterior versus posterior approach with subtotal corpectomy,decompression,and reconstruction of spine in the treatment of thoracolumbar burst fractures.Methods A total of 47 patients with thoracolumbar burst fractures were divided into 2 groups according to surgical approaches.Group A underwent lateral position one-stage plus anteroposterior approach while group B had posterior approach with subtotal corpectomy,decompression and reconstruction of spine.During a follow-up period of 36-68 months,their clinical and radiological outcomes were retrospectively evaluated.The perioperative volume of blood loss,operative duration,complications,pulmonary functions,Frankel scale and American Spinal Injury Association (ASIA) motor scores were recorded and analyzed.And the heights of anterior edge of vertebral body and Cobb angle were examined for radiological outcomes.Results At the latest follow-up,all patients achieved solid fusion with significant neurological improvements.The perioperative volumes of blood loss were less,operative duration was shorter and postoperative pulmonary functions were better in the group B (P ＜ 0.05).The ASIA motor score and radiological outcomes were not significantly different at all timepoints between two groups (P ＜ 0.05).But the neurological functions of two groups improved by approximately 1.4 Frankel grade (group A) versus 1.41 (group B) at the final follow-up.Conclusion Lateral position one-stage plus anteroposterior and posterior approaches with subtotal corpectomy,decompression,and reconstruction of spine are adequate surgical treatments for thoracolumbar burst fractures.But the latter has the major advantages of less perioperative volume of blood loss,fewer complications,shorter operative duration and better pulmonary functions.