CAJ | 학술논문

目的：探讨经伤椎椎弓根复位固定不植骨融合治疗无神经损伤的不稳定型胸腰椎骨折的临床疗效。方法回顾性分析2008年7月～2011年6月间收治的44例无神经损伤的不稳定型胸腰椎骨折，男性28例，女性16例；年龄22～57岁，平均36.8岁。采用急诊全麻下先行双踝悬吊法手法复位，再经后正中入路经伤椎短节段椎弓根螺钉内固定（6钉2棒1横联），术中不需要植骨融合。术后6周内卧床功能锻炼，3个月内戴支具下床活动，术后10～12个月拆除内固定装置。观察手术时间、出血量、并发症情况、Cobb角、伤椎前缘高度比值及视觉模拟评分（ VAS）。结果44例术后获得10～16个月（平均12.4个月）随访。手术时间50～105min，平均70min；术中出血量为100～400mL，平均200mL；术中及术后均未出现神经损伤、伤口感染等并发症； Cobb角术前26.3°±4.7°，术后4.3°±1.4°，拆除内固定时5.2°±1.2°；椎体前缘高度比值术前43.3％±14.7％，术后97.3％±4.4％，拆除内固定时96.3％±3.4％； VAS疼痛评分术前7.6±0.5，拆除内固定时1.2±0.4。所有患者均无内固定物松动断裂。结论经伤椎椎弓根复位固定不植骨融合治疗无神经损伤的不稳定型胸腰椎骨折，手术创伤小，固定牢固，能够很好地矫正后凸畸形，恢复并维持伤椎高度；伤椎愈合后即可恢复脊柱的稳定性无需植骨融合，及时拆除内固定物可以避免其松动断裂。
목적：탐토경상추추궁근복위고정불식골융합치료무신경손상적불은정형흉요추골절적림상료효。방법회고성분석2008년7월～2011년6월간수치적44례무신경손상적불은정형흉요추골절，남성28례，녀성16례；년령22～57세，평균36.8세。채용급진전마하선행쌍과현조법수법복위，재경후정중입로경상추단절단추궁근라정내고정（6정2봉1횡련），술중불수요식골융합。술후6주내와상공능단련，3개월내대지구하상활동，술후10～12개월탁제내고정장치。관찰수술시간、출혈량、병발증정황、Cobb각、상추전연고도비치급시각모의평분（ VAS）。결과44례술후획득10～16개월（평균12.4개월）수방。수술시간50～105min，평균70min；술중출혈량위100～400mL，평균200mL；술중급술후균미출현신경손상、상구감염등병발증； Cobb각술전26.3°±4.7°，술후4.3°±1.4°，탁제내고정시5.2°±1.2°；추체전연고도비치술전43.3％±14.7％，술후97.3％±4.4％，탁제내고정시96.3％±3.4％； VAS동통평분술전7.6±0.5，탁제내고정시1.2±0.4。소유환자균무내고정물송동단렬。결론경상추추궁근복위고정불식골융합치료무신경손상적불은정형흉요추골절，수술창상소，고정뢰고，능구흔호지교정후철기형，회복병유지상추고도；상추유합후즉가회복척주적은정성무수식골융합，급시탁제내고정물가이피면기송동단렬。
Objective To investigate the clinical efficacy of the fixation via injured vertebra pedicle for treating unstable thoracolumbar fractures without nerve injury.Methods From Jul.2008 to Jun.2011,we treated 44 patients(28 males and 16 females aged from 22-57 years,average 36.8 years) with unstable thoracolumbar frac-tures without nerve injury.Manipulative reduction by ankle suspension method was employed under general anesthe-sia.Then screw fixation via vertebral pedicle with the posterior median approach(6 nails,2 rods,1 rank) was per-formed without bone graft fusion surgery.Bed exercise function was encouraged within 6 weeks after the operation. A brace of ambulation were worn within 3 months,and the internal fixation device was removed 10-12 months after operation.The operation time,bleeding volume,complications,Cobb’ s angle,anterior vertebral height ratio and VAS score were observed.Results A total of 44 patients received 10-16 months( average 12.4 months) of follow-up.The operation time was 50-105 minutes(average 70 minutes);intraoperative bleeding was 100-400mL(average 200mL);no nerve injury,wound infection or other complications occurred before or after operation;Cobb’ s angle was 26.3°±4.7°before operation,4.3°±1.4°after operation and 5.2°±1.2°after the removal of internal fixation;anterior vertebral body height ratio was 43.3% ± 14.7% before operation,97.3% ± 4.4% after operation and 96.3% ±3.4%after the removal of internal fixation;VAS pain score was 7.6 ±0.5 before operation and 1.2 ± 0.4 after the removal of internal fixation.Neither internal fixation loosening nor breakage was found in any patient. Conclusion Fixation via vertebral pedicle in the treatment of unstable thoracolumbar fractures without nerve injury can get a good effect,fix firmly,effectively correct the kyphosis, restore and maintain vertebral height.Spinal stabil-ity can be reconstructed after the healing of the injured vertebra without the need of bone graft fusion.Internal fixa-tion can be removed in a timely manner to avoid loosening or breakage.