CAJ | 학술논문

目的：探讨1期后路经Wiltse入路伤椎植骨并置钉治疗胸腰椎骨折的临床疗效。方法：2009年2月～2010年1月，对36例胸腰椎椎体骨折经Wiltse入路行椎弓根螺钉内固定、经伤椎一侧椎弓根进行椎体内植骨并行伤椎置钉治疗。其中男26例，女10例；年龄26～52岁，平均38岁。损伤椎体：T102例，T116例，T1212例，L110例，L26例。骨折根据Denis分类：爆裂型骨折10例，屈曲压缩型骨折26例。按Frankel分级：A级2例，B级4例，C级16例，D级10例，E级4例。从受伤至手术时间为8小时～6天，平均3．8天。在手术前后摄X线片测量骨折椎体相对高度及Cobb角恢复情况，通过Frankel分级评价神经功能改善情况。结果：患者均顺利完成手术，所有手术切口均Ⅰ期愈合。36例获随访，随访时间11～26个月，平均15个月。患者均顺利完成手术，术后切口全部Ⅰ期愈合。术前、术后伤椎椎体相对高度分别为52．8％±13．6％、89．6％±10．3％，术后骨折椎体相对高度较术前恢复明显，差异均有统计学意义（P ＜0．05）；术前、术后Cobb角分别为（19．2±2．3）°、（7．3±1．2）°，术后与术前比较恢复明显，差异均有统计学意义（ P ＜0．01）。通过Frankel分级评价脊髓功能改善情况。结论：经Wiltse入路伤椎椎弓根椎体内植骨并置钉治疗胸腰椎骨折临床疗效满意，重建了椎体高度，增加了脊柱前、中柱的稳定性，具有防止术后椎体高度丢失、减少内固定物松动、断裂等优点。
목적：탐토1기후로경Wiltse입로상추식골병치정치료흉요추골절적림상료효。방법：2009년2월～2010년1월，대36례흉요추추체골절경Wiltse입로행추궁근라정내고정、경상추일측추궁근진행추체내식골병행상추치정치료。기중남26례，녀10례；년령26～52세，평균38세。손상추체：T102례，T116례，T1212례，L110례，L26례。골절근거Denis분류：폭렬형골절10례，굴곡압축형골절26례。안Frankel분급：A급2례，B급4례，C급16례，D급10례，E급4례。종수상지수술시간위8소시～6천，평균3．8천。재수술전후섭X선편측량골절추체상대고도급Cobb각회복정황，통과Frankel분급평개신경공능개선정황。결과：환자균순리완성수술，소유수술절구균Ⅰ기유합。36례획수방，수방시간11～26개월，평균15개월。환자균순리완성수술，술후절구전부Ⅰ기유합。술전、술후상추추체상대고도분별위52．8％±13．6％、89．6％±10．3％，술후골절추체상대고도교술전회복명현，차이균유통계학의의（P ＜0．05）；술전、술후Cobb각분별위（19．2±2．3）°、（7．3±1．2）°，술후여술전비교회복명현，차이균유통계학의의（ P ＜0．01）。통과Frankel분급평개척수공능개선정황。결론：경Wiltse입로상추추궁근추체내식골병치정치료흉요추골절림상료효만의，중건료추체고도，증가료척주전、중주적은정성，구유방지술후추체고도주실、감소내고정물송동、단렬등우점。
Objective:To study the effectiveness of wiltse approach with transpedicular intervertebral bone graft and pedicle screws fixa-tion in injured vertebrae for the treatment of thoracolumbar fractures.Methods:Between February 2009 and January 2010, 36 patients with thoracolumbar fractures were treated by posterior short~segment fixation combined with Wiltse approach with transpedicular intervertabral bone graft and pedicle screw fixation in injured vertebrae.There were 26 males and 10 females with a mean age of 38 years ( range, 26~52 years).The injured vertebrae were located at T10 in 2 case, T11 in 6 cases, T12 in 12cases, L1 in 10 cases, L2 in 6 cases.According to Denis classification, there were 10 cases of burst fractures and 26 cases of compression fractures.The time between injury and operation was 8 hours to 6 days (mean, 3.6 days).The X~ray film was taken to measure the relative height of fractured vertebrae and Cobb angle, and Frankel classification was conducted to evaluate the function recovery of the spinal cord.Results:The operations were performed successful-ly, and incisions healed primarily.All the patients were followed up 11~26 months (mean, 15 months).The relative height of fractured vertebrae were 52.8% ±13.6%at preoperation, 89.6% ±10.3%at after operation, showing significant differences betweenpreoperation and postoperation (P <0.05), The Cobb angles were (19.2 ±2.3), (7.3 ±1.2)°, respectively, showing significant differences be-tween preoperation and postoperation (P <0.01), according to frankel criterion the nerves function recoved in different degrees.Conclu-sion:Treatment of thoracolumbar fractures with wiltse approach and transpedicular intervertebral bone graft and pedicle screw fixation in in-jured vertebrae has satisfactory effectiveness, which could reconstruct vertebral body height, increase the stability of anterior and middle col-umn of the injured vertebrae, and prevent height loss of the injured vertebrae and loosening of instrumentation.