CAJ | 학술논문

背景：AO-C型胸腰椎急性损伤是一种高能量、不稳定性损伤，导致胸腰椎骨折脱位，多伴有脊髓神经损伤，一般均需后路切开复位、减压、植骨融合、椎弓根钉棒系统多节段内固定，致使脊椎运动节段过多丧失、内植物大量应用。目的：探讨后路单节段椎弓根钉棒系统置入对AO-C1型胸腰椎骨折脱位的矫治效果。方法：从2008年1月至2013年12月，对17例AO-C1型胸腰椎骨折脱位患者进行随访。所有患者均一期经后路切开复位、椎弓根钉棒系统内固定，其中8例经脱位椎间隙相邻上下各一椎体4钉2棒单节段固定(4钉2棒组)，9例经脱位椎间隙相邻上下椎体行8钉2棒多节段固定(8钉2棒组)。比较两组手术时间、术中出血量；治疗前、治疗后1周及最后随访时，在患者X射线侧位片上测量伤椎后凸Cobb角，采用Frankel分级法进行神经功能评价，采用目测类比评分评估腰背痛程度。结果与结论：随访1-5年。两组手术时间比较差异有显著性意义，4钉2棒组优于8钉2棒组(P <0.05)；两组术中出血量比较差异无显著性意义。两组胸腰椎骨折脱位内固定后均明显矫正，腰背痛明显缓解。治疗前脊髓功能为Frankel A级的10例患者末次随访时2例恢复至E级，余8例双下肢瘫痪均未恢复；Frankel B级的2例均恢复至E级。伤椎后凸Cobb角、目测类比评分等指标，治疗后1周、末次随访时与治疗前比较，差异均有显著性意义(P <0.05)；而末次随访与治疗后1周比较，差异均无显著性意义；4钉2棒组、8钉2棒组间比较差异均无显著性意义。提示经脱位椎间隙4钉2棒单节段与8钉2棒多节段矫治C1型胸腰椎骨折脱位的疗效无差别。因此AO-C1型胸腰椎骨折脱位可选择4钉2棒置入单节段复位固定。
배경：AO-C형흉요추급성손상시일충고능량、불은정성손상，도치흉요추골절탈위，다반유척수신경손상，일반균수후로절개복위、감압、식골융합、추궁근정봉계통다절단내고정，치사척추운동절단과다상실、내식물대량응용。목적：탐토후로단절단추궁근정봉계통치입대AO-C1형흉요추골절탈위적교치효과。방법：종2008년1월지2013년12월，대17례AO-C1형흉요추골절탈위환자진행수방。소유환자균일기경후로절개복위、추궁근정봉계통내고정，기중8례경탈위추간극상린상하각일추체4정2봉단절단고정(4정2봉조)，9례경탈위추간극상린상하추체행8정2봉다절단고정(8정2봉조)。비교량조수술시간、술중출혈량；치료전、치료후1주급최후수방시，재환자X사선측위편상측량상추후철Cobb각，채용Frankel분급법진행신경공능평개，채용목측류비평분평고요배통정도。결과여결론：수방1-5년。량조수술시간비교차이유현저성의의，4정2봉조우우8정2봉조(P <0.05)；량조술중출혈량비교차이무현저성의의。량조흉요추골절탈위내고정후균명현교정，요배통명현완해。치료전척수공능위Frankel A급적10례환자말차수방시2례회복지E급，여8례쌍하지탄탄균미회복；Frankel B급적2례균회복지E급。상추후철Cobb각、목측류비평분등지표，치료후1주、말차수방시여치료전비교，차이균유현저성의의(P <0.05)；이말차수방여치료후1주비교，차이균무현저성의의；4정2봉조、8정2봉조간비교차이균무현저성의의。제시경탈위추간극4정2봉단절단여8정2봉다절단교치C1형흉요추골절탈위적료효무차별。인차AO-C1형흉요추골절탈위가선택4정2봉치입단절단복위고정。
BACKGROUND:The type AO-C1 thoracolumbar acute spine injury is a kind of high-energy instable injury, can cause thoracolumbar fracture-dislocation, and mainly associated with spinal nerve injury. Generaly, al needs to posterior open reduction, decompression, bone graft fusion and multiple-segmental internal fixation of pedicle screw rod system, which causes excessive loss of spinal movement segment and a large number of application of internal fixators. OBJECTIVE:To evaluate the treatment effect of posterior pedicle screw mono-segmental internal fixation for treatment of the type AO-C1 thoracolumbar vertebrae fracture-dislocations. METHODS:From January 2008 to December 2013, 17 cases of type AO-C1 thoracolumbar fracture-dislocation were folowed up. Al patients were treated with one-stage posterior open reduction and pedicle screw-rod fixation. Of them, eight cases received four screws and two rods for single-segment fixation in upper and lower vertebrae adjacent to intervertebral space after dislocation (4-screw 2-rod group). Nine cases received eight screws and two rods for multiple-segment fixation in the upper and lower vertebrae adjacent to intervertebral space after dislocation (8-screw 2-rod group). Operative time and intraoperative blood loss were compared between the two groups. The Cobb’s angle was measured on lateral X-ray film of two groups preoperatively and 1 week postoperatively and during the final folow-up. The neurological function was evaluated by Frankel classification. The visual analogue scale was adopted to assess the degree of low back pain. RESULTS AND CONCLUSION:Patients were folowed up for 1 to 5 years. Significant differences were detected in the operative time between the two groups, and operative time was better in the 4-screw 2-rod group than in the 8-screw 2-rod group (P < 0.05). No significant difference was found in intraoperative blood loss between the two groups. The deformity of fracture-dislocation had been corrected, and the pain of low back had significantly relieved in al patients after fixation. According to Frankel classification, two cases at Grade A were improved to Grade E, but eight cases at Grade A got no improvement after treatment. Two cases at Grade B were also improved to Grade E at the final folow-up. Significant differences in Cobb’s angle and visual analogue scale were detectable at 1 week postoperatively and during final folow-up as compared with preoperatively (P < 0.05), but no significant difference was visible between final folow-up and 1 week postoperatively. No significant difference in Cobb’s angle and visual analogue scale was observed between the 4-screw 2-rod group and 8-screw 2-rod group. Results indicate that there was no significant difference in the clinical efficacy between 4-screw 2-rod single-segment and 8-screw 2-rod multiple-segment fixation for treating type C1 thoracolumbar vertebrae fracture-dislocation. Therefore, AO-C1 thoracolumbar vertebrae fracture-dislocation could be treated with 4-screw 2-rod single-segment reduction fixation.