CAJ | 학술논문

目的：探讨普通椎弓根螺钉联合万向钉经伤锥内固定术治疗胸腰椎爆裂性骨折患者的临床效果。方法选取2010年1月至2014年1月深圳平乐骨伤科医院接受治疗的胸腰椎爆裂性骨折并损伤后1周无明显脊髓神经损伤患者60例，其中Atlas分型A型20例、B型20例、C型20例。患者均接受普通椎弓根螺钉联合万向钉经伤锥内固定术治疗，比较各组患者治疗前后的伤椎椎体前缘高度、Cbob角及椎管矢状径的临床改善状况，并比较疼痛程度视觉模拟评分（ VAS）得分情况。结果治疗后A型、B型、C型胸腰椎爆裂性患者的椎体前缘高度较治疗前显著增高[（96±16）％比（58±12）％，（96±15）％比（49±11）％，（96±16）％比（45±10）％，P＜0．01]、Cbob角较治疗前显著降低[（3．7±1．2）°比（15．2±5．7）°，（4．1±1．4）°比（16．7±5．0）°，（3．8±1．4）°比（17．0±4．9）°，P＜0．01]及椎管矢状径较治疗前显著增高[（89±16）％比（65±11）％，（88±15）％比（59± 11）％，（90±15）％比（65±11）％，P＜0．01]，治疗后，A型、B型、C型间的椎体前缘高度、Cbob角及椎管矢状径比较，差异均无统计学意义（ P＞0．05），而A、B、C型患者的VAS评分治疗后分别较治疗前显著降低[（2．33±0．35）分比（6．02±0．99）分、（3．55±1．33）分比（5．98±1．21）分、（3．56±1．90）分比（6．16±1．31）分，P＜0．01]，治疗后A型得分显著低于B型和C型（P＜0．05）。结论采用普通椎弓根螺钉联合万向钉经伤锥内固定术治疗胸腰椎爆裂性骨折有明显的临床疗效，可以明显改善Atlas分型为A、B、C类型胸腰椎患者的椎体前缘高度、Cbob角及椎管矢状径，明显缓解患者的疼痛症状，可以作为治疗胸腰椎爆裂性骨折患者的重要治疗方式进行临床推广。
목적：탐토보통추궁근라정연합만향정경상추내고정술치료흉요추폭렬성골절환자적림상효과。방법선취2010년1월지2014년1월심수평악골상과의원접수치료적흉요추폭렬성골절병손상후1주무명현척수신경손상환자60례，기중Atlas분형A형20례、B형20례、C형20례。환자균접수보통추궁근라정연합만향정경상추내고정술치료，비교각조환자치료전후적상추추체전연고도、Cbob각급추관시상경적림상개선상황，병비교동통정도시각모의평분（ VAS）득분정황。결과치료후A형、B형、C형흉요추폭렬성환자적추체전연고도교치료전현저증고[（96±16）％비（58±12）％，（96±15）％비（49±11）％，（96±16）％비（45±10）％，P＜0．01]、Cbob각교치료전현저강저[（3．7±1．2）°비（15．2±5．7）°，（4．1±1．4）°비（16．7±5．0）°，（3．8±1．4）°비（17．0±4．9）°，P＜0．01]급추관시상경교치료전현저증고[（89±16）％비（65±11）％，（88±15）％비（59± 11）％，（90±15）％비（65±11）％，P＜0．01]，치료후，A형、B형、C형간적추체전연고도、Cbob각급추관시상경비교，차이균무통계학의의（ P＞0．05），이A、B、C형환자적VAS평분치료후분별교치료전현저강저[（2．33±0．35）분비（6．02±0．99）분、（3．55±1．33）분비（5．98±1．21）분、（3．56±1．90）분비（6．16±1．31）분，P＜0．01]，치료후A형득분현저저우B형화C형（P＜0．05）。결론채용보통추궁근라정연합만향정경상추내고정술치료흉요추폭렬성골절유명현적림상료효，가이명현개선Atlas분형위A、B、C류형흉요추환자적추체전연고도、Cbob각급추관시상경，명현완해환자적동통증상，가이작위치료흉요추폭렬성골절환자적중요치료방식진행림상추엄。
Objective To investigate the clinical effect of common pedicle screw combined with univer-sal nail internal fixation via the injured cone for thoracolumbar burst fractures .Methods A total of 60 burst fracture patients without obvious spinal cord injuries at 1 week check in Shenzhen Pingle Orthopedics Hospi-tal from Jan.2010 to Jan.2014 were included in the research,according to the Atlas classification were:type A 20 cases,type B 20 cases,type C 20 cases.All patients received treatment of conventional pedicle screw combined with universal screw internal fixation via injured cone , and the clinical improvement of vertebral height,Cbob angle and sagittal diameter of the spinal canal,pain VAS scores of various types of patients were compared.Results The anterior vertebral height of all types of thoracolumbar patients significantly improved than before the treatment [(96 ±16)% vs (58 ±12)%,(96 ±15)% vs (49 ±11)%,(96 ± 16)% vs (45 ±10)%,P<0.01],Cbob angle significantly decreased than before treatment [(3.7 ±1.2)° vs (15.2 ±5.7)°,( 4.1 ±1.4)°vs (16.7 ±5.0)°,( 3.8 ±1.4)°vs (17.0 ±4.9)°,P <0.01] and sagittal diameter of the vertebral canal was significantly improved ofter the treatment[(89 ±16)% vs (65 ± 11)%,(88 ±15)% vs (59 ±11)%,( 90 ±15)% vs (65 ±11)%,P<0.01].There were not significant difference in the anterior vertebral height,Cbob anle and sagittal diameter of the vertebral canal of type A ,B, C patients (P>0.05).And VAS scores of type A,B,C patients were significantly reduced after the opera-tion[(2.33 ±0.35) vs (6.02 ±0.99),(3.55 ±1.33) vs (5.98 ±1.21),(3.56 ±1.90) vs (6.16 ± 1.31),P<0.01].After trentment VAS score of type A patients was significont lower than B,C patients. Conclusion The common pedicle screw combined with universal nail internal fixation via the injured cone for thoracolumbar burst fractures has obvious clinical effect ,which can significantly improve the anterior ver-tebral height,Cbob angle and sagittal diameter of spinal canal of A,B,C Atlas type patients,and relieve the pain symptoms,thus can be used as an important treatment of thoracolumbar burst fracture in clinical .