CAJ | 학술논문

目的探讨后路经椎弓根钉内固定治疗合并后方韧带复合体(PLC)损伤的胸腰椎骨折早期临床疗效.方法回顾性分析2008年7月-2013年3月行手术治疗的合并PLC损伤胸腰椎屈曲分离型骨折患者22例,其中男16例,女6例;年龄23 ～62岁,平均39岁.所有患者病情稳定后,在静吸复合麻醉下行后路椎弓根螺钉内固定术.根据骨折移位的程度及韧带损伤的类型行后外侧和(或)椎体间自体植骨.观察术前、术后3d、随访末期的椎体高度恢复率、Cobb角矫正率、美国脊髓损伤协会(ASIA)分级.结果所有患者手术顺利,术中未发生手术并发症;患者均获得随访5～51个月(平均26.5个月).骨折复位满意,分离的后部结构闭合.椎体前缘高度术后较术前平均改善20.6％ (P ＜0.01);Cobb角术后较术前平均改善10.60°(P＜0.01).术前有神经损伤的8例术后均有不同程度恢复;术后感觉评分较术前平均改善20.7％ (P ＜0.05),运动功能评分较术前改善30.9％ (P ＜0.01).CT三维重建示植骨全部骨性愈合;患者无局部疼痛及内固定物断裂.结论后路经椎弓根钉内固定手术治疗合并PLC损伤的胸腰椎屈曲分离型骨折短期疗效满意,钉棒固定可以达到满意复位、骨折失稳脊柱的三柱即刻稳定;充分植骨是获得永久性稳定的保障.
목적 탐토후로경추궁근정내고정치료합병후방인대복합체(PLC)손상적흉요추골절조기림상료효.방법 회고성분석2008년7월-2013년3월행수술치료적합병PLC손상흉요추굴곡분리형골절환자22례,기중남16례,녀6례;년령23 ～62세,평균39세.소유환자병정은정후,재정흡복합마취하행후로추궁근라정내고정술.근거골절이위적정도급인대손상적류형행후외측화(혹)추체간자체식골.관찰술전、술후3d、수방말기적추체고도회복솔、Cobb각교정솔、미국척수손상협회(ASIA)분급.결과 소유환자수술순리,술중미발생수술병발증;환자균획득수방5～51개월(평균26.5개월).골절복위만의,분리적후부결구폐합.추체전연고도술후교술전평균개선20.6％ (P ＜0.01);Cobb각술후교술전평균개선10.60°(P＜0.01).술전유신경손상적8례술후균유불동정도회복;술후감각평분교술전평균개선20.7％ (P ＜0.05),운동공능평분교술전개선30.9％ (P ＜0.01).CT삼유중건시식골전부골성유합;환자무국부동통급내고정물단렬.결론 후로경추궁근정내고정수술치료합병PLC손상적흉요추굴곡분리형골절단기료효만의,정봉고정가이체도만의복위、골절실은척주적삼주즉각은정;충분식골시획득영구성은정적보장.
Objective To investigate the preliminary clinical result of thoracolumbar fracture combined with posterior ligamentous complex injuries repaired by posterior transpedicular screw fixation.Methods A retrospective review was performed on 22 patients with thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries treated with transpedicular screw fixation from July 2008 to March 2013.There were 16 males and 6 females with mean age of 39 years (range,23-62 years).After medically stable,posterior pedicle screw fixation was performed under intravenousinhalational anesthesia.According to the degree of fracture displacement and types of ligament injury,posterolateral bone grafting or intervertebral fusion at the level of injury was conducted.Vertebral height restoration,Cobb' s angle and American Spinal Injury Association (ASIA) score were reviewed preoperatively,at postoperative 3 days and at the last follow-up.Results All the patients were operated on smoothly.There were no complications during operation.All the patients were followed up for 5-51 months (mean,26.5 months).Fracture reductions were satisfied with the closure of vertebral posterior element.Mean anterior vertebral height and Cobb' s angle improved by 20.6％ and 10.60°respectively after operation (P ＜0.01).Eight patients with neurological dysfunction showed some recovery after operation with the mean sensory score improved by 20.7％ (P ＜ 0.05) and mean motor function score improved by 30.9％ (P ＜ 0.0l).All bone grafts were healed,without pain,loosening or breakage in the fixation system.Conclusions Posterior pedicular screw fixation attains good short-term outcome for thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries.The surgery provides satisfactory reduction and instant spinal three-column stability for the unstable spine fracture.Sufficient bone graft is the guarantee to permanent stability.