CAJ | 학술논문

目的探讨无脊髓损伤胸腰椎骨折脱位的治疗原则与手术方法.方法自2008年1月~2011年1月,对12例无脊髓损伤胸腰椎骨折脱位的患者,11例在后路长节段椎弓根螺钉固定融合术的基础上应用术中跨责任椎单侧钉棒预置脊髓保护技术+伤椎置钉及经椎弓根植骨技术+责任椎置钉阶梯减压复位技术,1例患者因骨折脱位严重,术前评估复位困难,术中行椎管减压后原位融合内固定,经过6~30个月(平均19.6个月)的随访,随访内容包括术后、术后3个月、6个月、12个月对腰痛VAS评分、神经功能障碍情况(Fankel分级)、胸椎稳定性和影像学检查,影像学检查包括X线、CT,在侧位X线片上测量伤椎复位情况及椎体前缘高度、脊柱后凸角度(Cobb角)及内固定物状况,在CT上评估植骨愈合情况.结果所有患者均得到随访,术后VAS评分0分9例,1分2例,2分1例,神经功能无损伤. X线检查除1例原位融合内固定患者外,余11例术后伤椎完全复位、椎体前缘高度恢复至正常的94.3%,Cobb角为5°.12例患者随访椎体高度及Cobb角度无丢失,无内固定断裂、松动、脱出,所有患者均获骨性愈合.结论对于无脊髓损伤胸腰椎骨折脱位,要根据个体情况制定相应的手术方案,后路长节段椎弓根螺钉固定融合术的基础上应用术中跨责任椎单侧钉棒预置脊髓保护技术+伤椎置钉及经椎弓根植骨技术+责任椎置钉阶梯减压复位技术是治疗无脊髓损伤型胸腰椎骨折脱位的有效方法;对于骨折脱位严重、手术强行复位易导致脊髓及邻近重要组织损伤者,可选择原位融合内固定术.
목적탐토무척수손상흉요추골절탈위적치료원칙여수술방법.방법자2008년1월~2011년1월,대12례무척수손상흉요추골절탈위적환자,11례재후로장절단추궁근라정고정융합술적기출상응용술중과책임추단측정봉예치척수보호기술+상추치정급경추궁근식골기술+책임추치정계제감압복위기술,1례환자인골절탈위엄중,술전평고복위곤난,술중행추관감압후원위융합내고정,경과6~30개월(평균19.6개월)적수방,수방내용포괄술후、술후3개월、6개월、12개월대요통VAS평분、신경공능장애정황(Fankel분급)、흉추은정성화영상학검사,영상학검사포괄X선、CT,재측위X선편상측량상추복위정황급추체전연고도、척주후철각도(Cobb각)급내고정물상황,재CT상평고식골유합정황.결과소유환자균득도수방,술후VAS평분0분9례,1분2례,2분1례,신경공능무손상. X선검사제1례원위융합내고정환자외,여11례술후상추완전복위、추체전연고도회복지정상적94.3%,Cobb각위5°.12례환자수방추체고도급Cobb각도무주실,무내고정단렬、송동、탈출,소유환자균획골성유합.결론대우무척수손상흉요추골절탈위,요근거개체정황제정상응적수술방안,후로장절단추궁근라정고정융합술적기출상응용술중과책임추단측정봉예치척수보호기술+상추치정급경추궁근식골기술+책임추치정계제감압복위기술시치료무척수손상형흉요추골절탈위적유효방법;대우골절탈위엄중、수술강행복위역도치척수급린근중요조직손상자,가선택원위융합내고정술.
Objective To explore the principles of treatment and surgical methods of research for thoracic and lumbar fractures dislocation without spinal cord injury .Methods From January of 2008 to January of 2011,12 pa-tients with thoracic and lumbar fractures dislocation without spinal cord injury were treated .Eleven patients were treated with long-segment pedicle screw fixation and fusion with the techniques of spinal cord protection by prepositioning inter -nal fixation unilaterally+the fractured vertebral set screws and transpedicular bone grafting +the fractured vertebral set screws ladder decompression and reduction ,1 patient was treated with spinal canal decompression in situ fusion and in-ternal fixation due to fracture dislocation severe and preoperative assessment reduction difficult .After 6 ~30 months (mean 19.6 months) follow-up,included low back pain VAS score ,neurological dysfunction situation (Fankel grading) and imaging examination of 3 months,6 months,12months after surgery.Imaging examination,including X-ray,CT.The reduction of fractured vertebral body,the leading edge of the vertebral body height ,kyphosis(Cobb angle) and the status of the internal fixation were measured in the lateral X-ray,bone graft healing was assessed in CT .Results All patients @@@@were followed up,postoperative VAS score of 0 scale(9 patients),1 scale(2 patient),2 scale(1 patient),neurological function without injury.X-ray examination indicated the fractured vertebral body restored completely except 1case which in situ fusion and internal fixation ,the anterior vertebral height restoration to normal 94.3%,Cobb angle of 5°.The fol-low-ups of vertebral height and Cobb angle remained well without internal fixation breaking loose and prolapse .All 11 pa-tients were bone healing.Conclusion For thoracic and lumbar fracture and dislocation without spinal cord injury ,we must develop appropriate surgical options according to individual circumstances .The long-segment pedicle screw fixation and fusion with the techniques of spinal cord protection by prepositioning internal fixation unilaterally +the fractured vertebral set screws and transpedicular bone grafting +the fractured vertebral set screws ladder decompression and re-duction is an effective method to treat thoracic and lumbar three-column fractures dislocation without spinal cord injury . For the patients who are difficult to reset and easy to injure spinal cord and adjacent important tissue ,we can choose in situ fusion and internal fixation.