CAJ | 학술논문

目的：探讨后路经皮穿刺空心椎弓根螺钉内固定治疗胸腰椎骨折可行性及其疗效。方法选择26例损伤平面以下无神经功能损害无需进行椎板减压的单纯胸腰椎骨折患者,Denis 三柱分型均为不稳定骨折,后路复位固定手术指针明确。在 C 臂机定位下行椎弓根穿刺,透视穿刺针,正、侧位片确认位于椎弓根内合适位置,切开皮肤约1．5 cm,依次攻丝,植入万向椎弓根螺钉,撑开、复位和固定。采用视觉模拟疼痛评分(VAS)、功能障碍指数(ODI)以及测量 Cobb 角评定疗效。结果患者均顺利完成手术,无切口感染、神经根或者脊髓损伤等并发症。手术时间35~80(60±15)min,术中出血量40~110(85±10)ml。患者均获随访,时间18~32个月。 VAS 术前7．8分±1．1分、术后2．0分±0．6分；Cobb 角术前45．1°±3．5°、术后6．3°±3．6°；两项指标与术前比较差异均有统计学意义(P <0．05)。术后椎体前缘高度及后凸畸形得到矫正。内固定取出后复查 X 线 Cobb 角为7．8°±1．4°,与术后比较差异无统计学意义(P =0．52),椎体高度无明显丢失。术后1个月 ODI 评分8．0分±0．6分,取出内固定 ODI 评分6．5 分 ± 0．8 分(P <0．05)。术后12~26个月取出内固定,无内固定断裂患者。结论后路经皮穿刺空心椎弓根螺钉内固定技术适合无需减压(或椎管探查)的胸腰椎骨折。
목적：탐토후로경피천자공심추궁근라정내고정치료흉요추골절가행성급기료효。방법선택26례손상평면이하무신경공능손해무수진행추판감압적단순흉요추골절환자,Denis 삼주분형균위불은정골절,후로복위고정수술지침명학。재 C 비궤정위하행추궁근천자,투시천자침,정、측위편학인위우추궁근내합괄위치,절개피부약1．5 cm,의차공사,식입만향추궁근라정,탱개、복위화고정。채용시각모의동통평분(VAS)、공능장애지수(ODI)이급측량 Cobb 각평정료효。결과환자균순리완성수술,무절구감염、신경근혹자척수손상등병발증。수술시간35~80(60±15)min,술중출혈량40~110(85±10)ml。환자균획수방,시간18~32개월。 VAS 술전7．8분±1．1분、술후2．0분±0．6분；Cobb 각술전45．1°±3．5°、술후6．3°±3．6°；량항지표여술전비교차이균유통계학의의(P <0．05)。술후추체전연고도급후철기형득도교정。내고정취출후복사 X 선 Cobb 각위7．8°±1．4°,여술후비교차이무통계학의의(P =0．52),추체고도무명현주실。술후1개월 ODI 평분8．0분±0．6분,취출내고정 ODI 평분6．5 분 ± 0．8 분(P <0．05)。술후12~26개월취출내고정,무내고정단렬환자。결론후로경피천자공심추궁근라정내고정기술괄합무수감압(혹추관탐사)적흉요추골절。
Objective To discuss the feasibility and clinical effects of posterior percutaneous cannulated pedicle screw fixation in the treatment of thoracolumbar fractures. Methods A total 26 cases of pure thoracolumbar fractures without neural impairment were enrolled, who did not need laminotomy decompression. All cases were identified as three column fracture according to Denis classification and needed posterior approach. With the C-arm guiding the pedicle bases of affected segments, then punctured transpedicular, exposed through 4 small incisions (1. 5 cm), drilled with tap, implanted polyaxial pedicle screws and finished with distraction reduction fixation in sequence. Visu-al analogue scale (VAS), Oswestry disability index (ODI) and Cobb′s angle were used to assess the effects. Results All operations were completed successfully, and no complications such as incision infection, injuries of nerve root or spinal cord occurred. Operative time was 35 ~ 80(60 ± 15)min, and operative blood loss was 40 ~ 110(85 ± 10) ml. All patients had been followed up for 18 to 32 months. The VAS score had declined from 7. 8 ± 1. 1 preoperative-ly to 2. 0 ± 0. 6 postoperatively, which had significant statistical difference (P < 0. 05). Cobb′s angle was decreased from 45. 1° ± 3. 5° preoperatively to 6. 3° ± 3. 6° postoperatively,and the difference was significant (P < 0. 05). The anterior vertebra height and kyphosis were corrected after surgery. And it was 7. 8° ± 1. 4°after internal fixations re-moved, which compared to postoperative had no statistical difference(P = 0. 52). The vertebra height had scarcely any changed after removal internal fixations. The ODI score was 8. 0 ± 0. 6 one month after surgery and it was 6. 5 ± 0. 8 after internal fixations removed (P < 0. 05). No breakage occurred until removing internal fixations at 12 ~ 26 months postoperatively. Conclusions Posterior percutaneous cannulated pedicle screw fixation has good effect for the treatment of thoracolumbar fracture which don′t need laminotomy decompression.