CAJ | 학술논문

目的：探讨椎旁肌间隙入路内固定并经伤椎置入硫酸钙在胸腰段椎体骨折治疗中的临床疗效。方法自2011年12月至2013年12月对22例无需行椎管减压的胸腰段椎体骨折患者应用椎旁肌间隙入路螺钉复位固定同时经伤椎置入硫酸钙（SC 组）治疗，围术期和随访数据与2010年1月至2011年12月24例无需行椎管减压的胸腰段椎体骨折应用传统后入路椎弓根螺钉复位固定并椎板间植骨融合（ TO 组）的患者数据进行比较。对比两组患者术前、术后1周和12月时后凸 Cobb 角和椎体前缘高度，术后12月时腰痛 Oswestry 功能障碍指数（ODI）术前、术后1周、3个月、12月时疼痛视觉模拟评分（VAS），以及手术切口长度、手术时间、术中出血量和术后引流量。结果术前及术后1周两组患者骨折椎体前缘高度、后凸 Cobb 角之间无统计学差异，术后12月时，SC 组患者的骨折椎体前缘高度、后凸 Cobb 角略优于 TO 组，但统计学上无显著性差异，术后12月时 SC 组 ODI 优于 TO 组，有显著性差异。两组患者术前疼痛 VAS无差异，术后1周、3个月和12个月 SC 组明显低于 TO 组，差异有显著性（ P <0.05）。SC 组手术切口长度、手术时间、术中出血量、术后引流量和住院时间均优于 TO 组，差异有显著性（ P <0.05）。结论椎旁肌间隙入路融合了微创理念，结合伤椎置入硫酸钙对塌陷明显的骨折椎体能够更好地维持复位后的形状和改善症状，有利于患者的后期恢复。
목적：탐토추방기간극입로내고정병경상추치입류산개재흉요단추체골절치료중적림상료효。방법자2011년12월지2013년12월대22례무수행추관감압적흉요단추체골절환자응용추방기간극입로라정복위고정동시경상추치입류산개（SC 조）치료，위술기화수방수거여2010년1월지2011년12월24례무수행추관감압적흉요단추체골절응용전통후입로추궁근라정복위고정병추판간식골융합（ TO 조）적환자수거진행비교。대비량조환자술전、술후1주화12월시후철 Cobb 각화추체전연고도，술후12월시요통 Oswestry 공능장애지수（ODI）술전、술후1주、3개월、12월시동통시각모의평분（VAS），이급수술절구장도、수술시간、술중출혈량화술후인류량。결과술전급술후1주량조환자골절추체전연고도、후철 Cobb 각지간무통계학차이，술후12월시，SC 조환자적골절추체전연고도、후철 Cobb 각략우우 TO 조，단통계학상무현저성차이，술후12월시 SC 조 ODI 우우 TO 조，유현저성차이。량조환자술전동통 VAS무차이，술후1주、3개월화12개월 SC 조명현저우 TO 조，차이유현저성（ P <0.05）。SC 조수술절구장도、수술시간、술중출혈량、술후인류량화주원시간균우우 TO 조，차이유현저성（ P <0.05）。결론추방기간극입로융합료미창이념，결합상추치입류산개대탑함명현적골절추체능구경호지유지복위후적형상화개선증상，유리우환자적후기회복。
Objective To investigate the clinical results of thoraco - lumbar vertebra fracture treated with short - segment internal fixation combined with transpedicular calcium sulfate grafting through paraspinal muscle gap approach. Methods 22 patients who were diagnosed with fractures of thoracolumbar vertebra and treated with short - segment internal fixation combined with transpedicular calcium sulfate grafting through paraspinal muscle gap approach(group SC),from Dec,2011 to Dec,2013 were compared with 24 patients with the same diagnoses who were treated with traditional back median open pedicle screw osteosynthesis(group TO),chosen from database in the same unit from Jan,2010 to Dec, 2011. Perioperative and postoperative parameters from these cases in the two groups were compared. Results There is no difference in Cobbˋs an-gles of kyphos,the height of vertebral anterior edge and the Oswestry Disability Index(ODI)in two groups at the time of preoperation,one month and 12 months postoperation,but the VAS of one week,3 months and 12 months of postoperative in group SC were all lower than those of group TO. Compared with traditional group,the length of incision,the operation time and duration of hospital stay shorted significantly in group SC. Voth operative bleeding volume and postoperative drainage volume decreased significantly in group SC,compared with group TO. Conclusion The paraspinal muscle gap approach is minimal invasive. Short - segment internal fixation combined with calcium sulfate grafting into collapse -fracture vertabra would maintain the height and Cobb′s angles of kyphos of restored vetebras,eliminate the complications of autologous bone grafting and have a significantly positive effect on functional results.