CAJ | 학술논문

目的：探讨经后路椎体次全切除治疗胸腰段爆裂骨折伴脊髓损伤的适应证及临床疗效。方法采用后路椎体次全切除椎管减压治疗41例伴脊髓、神经损伤的胸腰段爆裂骨折患者。比较术前及末次随访神经功能 ASIA 分级、伤椎前缘高度、后凸 Cobb 角,观察椎管容积率。结果手术时间180~290 min,术中出血量600~2 400 ml。所有患者伤口均一期愈合,无肺部感染。41例均获得随访,时间12~24个月。植骨均顺利融合,内固定无松动、断裂；椎体高度、曲度和椎管容积无明显丢失。术后6个月 ASIA 分级： A 级5例无恢复；B 级9例恢复至 C 级2例、 D 级5例、 E 级1例,1例无恢复；C 级13例恢复至 D 级5例、 E 级6例,2例无恢复；D 级14例恢复至 E 级13例,1例无恢复。 Cobb 角：术前23．6°±2．7°,术后6个月为6．4°±0．8°,P <0．01。椎管容积率：术前49．03%±6．04%,术后6个月为98．09%±0．98%,P <0．01。结论后路椎体次全切除、减压内固定治疗合并有肺挫伤、关节交锁、后方韧带复合体结构断裂等的胸腰椎爆裂性骨折并脊髓损伤,可有效恢复椎体高度、椎管容积及 Cobb 角度,减压彻底,是一种安全、有效的手术方法。
목적：탐토경후로추체차전절제치료흉요단폭렬골절반척수손상적괄응증급림상료효。방법채용후로추체차전절제추관감압치료41례반척수、신경손상적흉요단폭렬골절환자。비교술전급말차수방신경공능 ASIA 분급、상추전연고도、후철 Cobb 각,관찰추관용적솔。결과수술시간180~290 min,술중출혈량600~2 400 ml。소유환자상구균일기유합,무폐부감염。41례균획득수방,시간12~24개월。식골균순리융합,내고정무송동、단렬；추체고도、곡도화추관용적무명현주실。술후6개월 ASIA 분급： A 급5례무회복；B 급9례회복지 C 급2례、 D 급5례、 E 급1례,1례무회복；C 급13례회복지 D 급5례、 E 급6례,2례무회복；D 급14례회복지 E 급13례,1례무회복。 Cobb 각：술전23．6°±2．7°,술후6개월위6．4°±0．8°,P <0．01。추관용적솔：술전49．03%±6．04%,술후6개월위98．09%±0．98%,P <0．01。결론후로추체차전절제、감압내고정치료합병유폐좌상、관절교쇄、후방인대복합체결구단렬등적흉요추폭렬성골절병척수손상,가유효회복추체고도、추관용적급 Cobb 각도,감압철저,시일충안전、유효적수술방법。
Objective To investigate the indications and clinical effect of posterior approach for spine reconstruction with subtotal vertebrectomy, decompression and internal fixation for thoracolumbar vertebra burst fractures with spinal cord injuries. Methods 41 patients with thoracolumbar veterbra burst fractures were treated with posterior approach for spine reconstruction with subtotal vertebrectomy, decompression and internal fixation were analyzed retrospective-ly. Results The operative time was 180 ~ 290 min, the hemorrhage was 600 ~ 2 400 ml,and the follow-up time was 12 ~ 24 months. All incisions were primary healing, and no lung infection was occurred. All the follow-up patients were obtained excellent fusion of bone graft. There were no serious complications related to internal fixation, and re-covered vertebral body height was achieved in all cases. Six months after surgery,ASIA classification:5 cases of grade A without recovery; 9 cases of grade B recovered to grade C in 2 cases, grade D in 5 cases and E in 1 case, but 1 case without recovery; 13 cases of grade C recovered to D in 5, E in 6, and 2 cases without recovery; 14 cases with grade D improved to grade E in 13 cases, but 1 case of no recovery. The Cobb′s angle was rectified from 23. 6° ± 2. 7°preoperatively to 6. 4° ± 0. 8°postoperatively, P < 0. 01,and the spinal canal volume increased from 49. 03% ± 6. 04% preoperatively to 98. 09% ± 0. 98% postoperatively, P < 0. 01. Conclusions Posterior approach for spine reconstruction with subtotal vertebrectomy, decompression and internal fixation is an excellent method for thoracolum-bar vertebra burst fractures with spinal cord injuries, especially associated pulmonary contusion, locked-facet and lamina fracture. It is a safe and effective operation method with the advantages of recovered of the vertebral body height, the spinal canal volume, and the Cobb′s angle.