CAJ | 학술논문

目的：探讨脊柱胸腰段骨折后长期椎弓根螺钉固定对关节突关节的影响。方法回顾分析胸腰段骨折后经椎旁肌入路椎弓根螺钉长期固定后取除固定装置51名患者资料。其中男性35例，女性16例，年龄21～57岁，平均年龄为（39.42±9.63）岁。筛选标准：受伤当时骨折类型为压缩骨折，没有后柱损伤的爆裂骨折，椎管占位＜1／3，没有神经损伤，Frankle／A- SIA[1]分级为E级，椎弓根螺钉固定时关节突关节无退变，胸腰段骨折后经椎旁肌入路行椎弓根螺钉固定术；固定时间大于1年，经椎旁肌入路取除固定装置。通过矢状位动态X线检查测量固定过的椎体伸屈活动度，CT观察固定范围内的关节突关节的变化，术后疼痛视觉模拟评分（VAS评分）。结果矢状位动态X线检查Cobb角，配对t检验，P＞0.05，伸屈位角度没有统计学差异；C T检查，以单个关节突关节为观察对象，关节突关节关节间隙狭窄75.49％，关节间隙连续性中断10.29％，完整骨痂形成1.47％。结论长期固定后关节突关节即使没有达到骨性融合，也可造成关节突关节活动度消失。
목적：탐토척주흉요단골절후장기추궁근라정고정대관절돌관절적영향。방법회고분석흉요단골절후경추방기입로추궁근라정장기고정후취제고정장치51명환자자료。기중남성35례，녀성16례，년령21～57세，평균년령위（39.42±9.63）세。사선표준：수상당시골절류형위압축골절，몰유후주손상적폭렬골절，추관점위＜1／3，몰유신경손상，Frankle／A- SIA[1]분급위E급，추궁근라정고정시관절돌관절무퇴변，흉요단골절후경추방기입로행추궁근라정고정술；고정시간대우1년，경추방기입로취제고정장치。통과시상위동태X선검사측량고정과적추체신굴활동도，CT관찰고정범위내적관절돌관절적변화，술후동통시각모의평분（VAS평분）。결과시상위동태X선검사Cobb각，배대t검험，P＞0.05，신굴위각도몰유통계학차이；C T검사，이단개관절돌관절위관찰대상，관절돌관절관절간극협착75.49％，관절간극련속성중단10.29％，완정골가형성1.47％。결론장기고정후관절돌관절즉사몰유체도골성융합，야가조성관절돌관절활동도소실。
Objective To explore the effect of long-term fixation on zygapophyseal joint after thoracolumbar fractures .Meth- ods The data of 51 patients with thoracolumbar fracture treated surgery with pedicle screw fixation through the approach be- tween the para-vertebral muscle then removed the fixation recently to analyze the zygapophyseal joint changes after long-term fixation were retrospectively observed .51 patients ,35 cases of male ,16 cases of female ,aged from 21 to 57 years old ,aver- aged (39.42 ± 9.63) years old ,were analyzed .All adopted cases used the following standards :thoracolumbar compression frac- ture or thoracolumbar burst fracture without posterior column damaged ;spinal canal space-occupying less than 1/3;no neuro- logical damage(ASIA E);no zygapophyseal joint degeneration before pedicle screw fixation;the thoracolunmbar fixated more than one year ;remove the pedical screw fixation through the para-vertebral muscle .The range of motion of the thoracolumbar that had ever been fixated using the sagittal hypertention-hyperflextion X-Ray radiography was measured .The degeneration changes of the zygapophyseal using CT scans were observed and the patients graded by VAS .Results The paired t test showed that there was no significant difference between sagittal Cobb's angle in the hypertension X-Ray radiography and in the hyper- flexion X-Ray radiography(P>0.05) .In the CT scanning ,every single zygapophyseal was observed ,75 .49% of them showed facet joint space narrowing ,10 .29% of them showed interruption of the facet joint space ,1 .47% of them surrounded by bony callus .Conclusion Suffered long-term fixation although the zygapophyseal joint are not bony fusion ,the range of motion of zyg- apophyseal joint may disappear .