CAJ | 학술논문

目的：探讨后路单侧伤椎植入螺钉结合经伤椎椎弓根植骨治疗胸腰椎骨折的临床疗效。方法：对30例胸腰椎骨折实施经单侧伤椎椎弓根钉固定结合经椎弓根植骨术治疗，术前伤椎前缘高度平均40％，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7例，C级6例，D级10例，E级5例，疼痛评分（VAS）平均8．5分。结果：术后随访6～36个月，30例患者术后疼痛明显缓解，术后VAS评分平均2分，伤椎前缘平均高度恢复到95％，脊柱后凸角（ Cobb角）为3．5°，椎管正中矢状径恢复到95％，VAS评分为1．5分，手术前后差异显著（ P＜0．05）。术后神经功能恢复情况：A级1例，B级2例，C级4例，D级6例，E级17例。术后骨折均获得复位，无1例发生内固定断裂、松动，矫正丢失等并发症。结论：经后路单侧伤椎椎弓根钉内固定结合经椎弓根植骨术能重建椎体高度，使脊柱的载荷分布更加合理，增强脊柱的抗压稳定性，减轻腰背部疼痛，降低内固定失败率，是一种治疗胸腰椎骨折的有效方法之一。
목적：탐토후로단측상추식입라정결합경상추추궁근식골치료흉요추골절적림상료효。방법：대30례흉요추골절실시경단측상추추궁근정고정결합경추궁근식골술치료，술전상추전연고도평균40％，척주후철각（ Cobb각）25°，추관정중시상경60％，신경공능안Frankel분급：A급2례，B급7례，C급6례，D급10례，E급5례，동통평분（VAS）평균8．5분。결과：술후수방6～36개월，30례환자술후동통명현완해，술후VAS평분평균2분，상추전연평균고도회복도95％，척주후철각（ Cobb각）위3．5°，추관정중시상경회복도95％，VAS평분위1．5분，수술전후차이현저（ P＜0．05）。술후신경공능회복정황：A급1례，B급2례，C급4례，D급6례，E급17례。술후골절균획득복위，무1례발생내고정단렬、송동，교정주실등병발증。결론：경후로단측상추추궁근정내고정결합경추궁근식골술능중건추체고도，사척주적재하분포경가합리，증강척주적항압은정성，감경요배부동통，강저내고정실패솔，시일충치료흉요추골절적유효방법지일。
Obej ctive:To investigate curative effect for thoracolumbar fractures by the method of unilateral vertebral pedicle screw fixa -tion with transpedicular bone graft.Methods:30 cases of thoracolumbar burst fractures were treated by unilateral vertebral pedicle screw fixation combining transpedicular bone graft.The average height of anterior border was 40%before the operation, the average of Cobb an-gle was 25°,the percentage of mid-sagital diameter was 60%.According to Frankelˊs neurological function classification,preoperative neurological function was Grade A in 2 cases, B in 7,C in 6, D in 10, E in 5.Visual Analogue Scale(VAS) classification preoperative average was 8.5.Results:All cases were followed up for 6 to 36 months .All patientsˊpain relieved distinctly, VAS score postoperative average was 2.The average height anterior border was increased to 95%, the average of Cobb angle was 3.5°,the percentage of midsagital diameter was 96% postoperatively,showing significant difference(P<0.05) before and after operation.The postoperative neurological function was improved:Grade A in 1 cases, Grade B in 2, Grade C in 4, Grade D in 6, Grade E in 17.All the fracture were reduced and the internal fixation didnˊt loose and break, and there no lost of correction and other complications.Conclusion:Unilateral vertebral pedi-cle screw fixation with transpedicular bone graft could not only reconstruct the height of verbebral fractured satisfactorily, making load of spine more reasonable and increasing the stability of spine,but also decrease the possibility of breaking nail and correction loss.Meanwhile it might be an effective method in treatment of thoracolumbar burst fractures.