CAJ | 학술논문

背景：既往研究大多采用回顾性、小样本分析应用椎弓根置钉技术修复胸腰椎骨折的近期临床效果，结论较为单薄。同时有学者提出经伤椎置入螺钉可进一步稳定椎体，减少断钉断棒、矫正度丢失等情况。目的：评价经伤椎椎弓根螺钉置入内固定修复胸腰椎骨折的远期效果。方法：选取2010年2月至2012年2月广州市番禺区第二人民医院骨科收治的36例胸腰椎骨折患者，应用经伤椎椎弓根螺钉置入内固定治疗。治疗前伤椎前缘高度比平均36%，脊柱后凸角(Cobb角)25°，椎管正中矢状径60%，神经功能按Frankel分级：A级2例，B级6例，C级10例，D级9例，E级9例。比较患者治疗前和治疗后的伤椎前缘高度比、脊柱后凸角(Cobb角)、椎管正中矢状径以及神经功能Frankel分级情况。结果与结论：治疗后随访3-3.5年，36例患者治疗后疼痛明显缓解，治疗后平均伤椎前缘高度比恢复到95%，脊柱后凸角(Cobb角)为3.5°，椎管正中矢状径恢复到96%，治疗前后患者的上述指标差异有显著性意义(P <0.05)。治疗后神经功能恢复情况：A级1例，B级2例，C级3例，D级4例，E级26例。治疗后骨折均获得复位，未发生内固定断裂、松动，矫正丢失等并发症。提示经伤椎椎弓根螺钉置入内固定修复胸腰椎骨折能让骨折获得满意复位，增强脊柱的抗压稳定性，减少内固定断裂和椎体高度丢失，远期效果良好，说明植入物与宿主具有良好的生物相容性。
배경：기왕연구대다채용회고성、소양본분석응용추궁근치정기술수복흉요추골절적근기림상효과，결론교위단박。동시유학자제출경상추치입라정가진일보은정추체，감소단정단봉、교정도주실등정황。목적：평개경상추추궁근라정치입내고정수복흉요추골절적원기효과。방법：선취2010년2월지2012년2월엄주시번우구제이인민의원골과수치적36례흉요추골절환자，응용경상추추궁근라정치입내고정치료。치료전상추전연고도비평균36%，척주후철각(Cobb각)25°，추관정중시상경60%，신경공능안Frankel분급：A급2례，B급6례，C급10례，D급9례，E급9례。비교환자치료전화치료후적상추전연고도비、척주후철각(Cobb각)、추관정중시상경이급신경공능Frankel분급정황。결과여결론：치료후수방3-3.5년，36례환자치료후동통명현완해，치료후평균상추전연고도비회복도95%，척주후철각(Cobb각)위3.5°，추관정중시상경회복도96%，치료전후환자적상술지표차이유현저성의의(P <0.05)。치료후신경공능회복정황：A급1례，B급2례，C급3례，D급4례，E급26례。치료후골절균획득복위，미발생내고정단렬、송동，교정주실등병발증。제시경상추추궁근라정치입내고정수복흉요추골절능양골절획득만의복위，증강척주적항압은정성，감소내고정단렬화추체고도주실，원기효과량호，설명식입물여숙주구유량호적생물상용성。
BACKGROUND:Many previous retrospective smal-sample studies analyzed the short-term effects using pedicle screw placement to repair thoracolumbar fracture. Conclusions are relatively thin. Simultaneously, screw placement in the injured vertebra can further stabilize the vertebral body, and reduce screw and rod breakage and loss of correction. OBJECTIVE:To evaluate the long-term effects of pedicle screw placement fixation through the injured vertebra in the repair of thoracolumbar fracture. METHODS: From February 2010 to February 2012, 36 patients with thoracolumbar fracture, who were treated in the Department of Orthopedics, Guangzhou Panyu District Second People’s Hospital, were selected. They were treated by vertebral pedicle screw placement fixation. Height ratio of preoperative injured vertebral leading edge was averagely 36%. Kyphosis angle (Cobb angle) was 25°. Sagittal diameter of the center of the vertebral canal was 60%. Nerve function was classified according to Frankel classification: grade A, 2 cases; grade B, 6 cases; grade C, 10 cases; grade D, 9 cases; grade E, 9 cases. The height ratio of injured vertebra, kyphosis angle (Cobb angle), sagittal diameter of the center of the vertebral canal and Frankel classification of nerve function were compared before and after treatment. RESULTS AND CONCLUSION: The postoperative folow-up was 3-3.5 years. Pain was obviously aleviated postoperatively in 36 patients. Average height ratio of injured vertebra was 95%. Kyphosis angle (Cobb angle) was 3.5°. Sagittal diameter of the center of the vertebral canal was 96%. Significant difference was found in the above indexes before and after treatment (P < 0.05). Postoperative neurologic recovery: grade A in 1 case, grade B in 2 cases, grade C in 3 cases, grade D in 4 cases, and grade E in 26 cases. Postoperative fractures were reset. Complications such as breakage, loosing or correction loss were not found. These findings suggest that pedicle screw placement fixation through the injured vertebra in the repair of thoracolumbar fracture can make a satisfactory reduction, enhance the pressure stability of the spine, reduce the internal fixation of fracture and vertebral height loss, and have good long-term effects, indicating that the implant and host have good biocompatibility.