CAJ | 학술논문

目的：观察直视下长短棒结合提拉复位内固定治疗伴神经损伤的重度创伤性腰椎骨折脱位在临床上的应用价值。方法回顾分析2010年～2013年解放军第89医院收治的35例伴神经损伤的重度腰椎骨折脱位采用后路直视下长短棒结合提拉复位内固定术，术后采用Suk标准判断植骨融合情况。结果平均手术时间约170min，出血量约600ml，术后随访脊柱植骨融合且稳定，术中未发现神经根及硬膜囊等医源性损伤。术后行脊柱正侧位X线检查，椎体脱位及旋转、成角移位均完全纠正，椎体前缘高度由术前的45％恢复到术后的95％．Cobb角从术前的32．5°±2．9°恢复至术后平均4．5°±2．2°。脊髓神经功能恢复按照Frankel截瘫分级，其中25例分别提高1～3级，10例A级无明显变化，术后3个月下地或坐轮椅，无迟发性脊髓损伤，未见断钉。结论重度骨折脱位伴神经损伤采用后路直视下长短棒结合提拉复位内固定术，可有效去除对神经的骨性压迫并重建脊柱的稳定性，融合率较高，安全有效。
목적：관찰직시하장단봉결합제랍복위내고정치료반신경손상적중도창상성요추골절탈위재림상상적응용개치。방법회고분석2010년～2013년해방군제89의원수치적35례반신경손상적중도요추골절탈위채용후로직시하장단봉결합제랍복위내고정술，술후채용Suk표준판단식골융합정황。결과평균수술시간약170min，출혈량약600ml，술후수방척주식골융합차은정，술중미발현신경근급경막낭등의원성손상。술후행척주정측위X선검사，추체탈위급선전、성각이위균완전규정，추체전연고도유술전적45％회복도술후적95％．Cobb각종술전적32．5°±2．9°회복지술후평균4．5°±2．2°。척수신경공능회복안조Frankel절탄분급，기중25례분별제고1～3급，10례A급무명현변화，술후3개월하지혹좌륜의，무지발성척수손상，미견단정。결론중도골절탈위반신경손상채용후로직시하장단봉결합제랍복위내고정술，가유효거제대신경적골성압박병중건척주적은정성，융합솔교고，안전유효。
[ ABSTRACT] Objective To observe the clinical application value of direct vision combined with the length of the rod pulling fixa -tion on lumbar fracture and dislocation with severe traumatic nerve injury .Methods Retrospective analysis of 35 cases of severe lumbar frac-ture and dislocation complicated with nerve injury in PLA 89th hospitals during 2010~2013 treated by pulling open reduction and internal fixation with posterior length under rod was made ,the treatment effect was evaluated by Suk standards .Results The average operation time ws about 170 minutes,blood loss was about 600ml,intraoperative nerve root and dural sac such as iatrogenic injury was not found and postop -erative follow-up showed stable spinal bone graft fusion .Postoperative lateral X -ray examination of the spine ,vertebrae dislocation and rota-tion,angular displacement were fully corrected ,Using Suk standard to determine bone fusion ,the anterior vertebral height restored from 45%preoperatively to 95%postoperatively.Cobb angle recovered from 32.5 °±2.9 °preoperative to an average of 4.5 °±2.2 °postoperative. Functional recovery of spinal cord paralysis graded according to Frankel ,of which 25 cases were increased by 1~3 grade,10 cases of A-level had no significant changes .After 3 months of ambulation or wheelchair ,no delayed spinal cord injury and no broken nails were found .Conclu-sion Fracture dislocation with severe nerve damage under direct vision with posterior fixation combined with the length of the rod pulling the reset,which can effectively remove bone compression of nerves and rebuild spinal stability with high fusion rate safely and effectively .