CAJ | 학술논문

目的探讨应用可移动单一小切口下双侧Wiltse入路手术治疗行胸腰椎骨折的治疗效果.方法对自2009年9月至2014年9月24例胸腰椎骨折患者资料进行回顾性研究,男14例,女10例;年龄20 ～ 45岁,平均31.2岁;所有患者均为单节段骨折,其中T81例,T101例,T11 3例,T12 10例,L1 8例,L21例.采用可移动切口经多裂肌和最长肌入路(Wiltse入路)行胸腰椎椎弓根螺钉内固定术.术前测量皮肤移动度,术前、术后及末次随访行胸腰段正、侧位X线片检查,并比较术前、术后视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI). 结果皮肤移动距离测量头向移动1.3 ～6.0 cm,平均(3.0±0.9) cm;尾向移动0.9～2.0 cm,平均(1.7±0.7)cm;纵向总移动4.0～6.2 cm,平均(4.8±0.4) cm.手术切口定位在骨折椎棘突上缘至头侧节段棘突上缘,长约5 cm,通过此切口的头尾侧移动,完成内固定手术操作.所有患者术后随访8～18个月,末次随访X线片均提示骨折复位满意,内固定未见松动或断裂.视觉模拟评分及Oswestry功能障碍指数术后均得到明显改善. 结论移动切口技术充分利用了人体皮肤可移动性,结合经多裂肌和最长肌入路,可以顺利完成胸腰椎手术.
목적 탐토응용가이동단일소절구하쌍측Wiltse입로수술치료행흉요추골절적치료효과.방법 대자2009년9월지2014년9월24례흉요추골절환자자료진행회고성연구,남14례,녀10례;년령20 ～ 45세,평균31.2세;소유환자균위단절단골절,기중T81례,T101례,T11 3례,T12 10례,L1 8례,L21례.채용가이동절구경다렬기화최장기입로(Wiltse입로)행흉요추추궁근라정내고정술.술전측량피부이동도,술전、술후급말차수방행흉요단정、측위X선편검사,병비교술전、술후시각모의평분(VAS)화Oswestry공능장애지수(ODI). 결과 피부이동거리측량두향이동1.3 ～6.0 cm,평균(3.0±0.9) cm;미향이동0.9～2.0 cm,평균(1.7±0.7)cm;종향총이동4.0～6.2 cm,평균(4.8±0.4) cm.수술절구정위재골절추극돌상연지두측절단극돌상연,장약5 cm,통과차절구적두미측이동,완성내고정수술조작.소유환자술후수방8～18개월,말차수방X선편균제시골절복위만의,내고정미견송동혹단렬.시각모의평분급Oswestry공능장애지수술후균득도명현개선. 결론 이동절구기술충분이용료인체피부가이동성,결합경다렬기화최장기입로,가이순리완성흉요추수술.
Objective To investigate the efficacy of surgery for thoracolumbar vertebral fracture using a movable window method.Methods From September 2009 through September 2014,24 patients with thoracolumbar vertebral fracture were treated at our department.They were 14 men and 10 women,with an average age of 31.2 years (range,20 to 45 years).All the patients suffered from fracture of single segment,involving T8 in one,T10 in one,T11 in 3,T12 in 10,L1 in 8,and L2 in one.All the patients were treated with pedicle screw fixation through the multifidus and longissimus approach (the Wiltse approach) using a movable incision window method.Preoperatively,the movable distance between cranial and caudal skin was measured.The anteroposterior and lateral X-ray films were taken for radiological evaluation at follow-ups.Clinical outcomes were also evaluated pre-and postoperatively using visual analog scale (VAS) and Oswestry disability index (ODI).Results The movable distance of skin:craniad:1.3 cm to 6.0 cm (mean,3.0 ±0.9 cm);caudad:0.9 cm to 2.0 cm (mean,1.7 ±0.7 cm);total longitudinal move:4.0 cm to 6.2 cm (mean,4.8 ±0.4 cm).The 5 cm incision,through which internal fixation was performed,was positioned between the lower margin of the index spinal process and the lower margin of the cranial spinal process.The follow-ups ranged from 8 to 18 months.The radiologicat findings at the last follow-up revealed satisfying fiacture reduction without loosening or breakage of the instrumentation.The VAS and ODI were significantly improved after surgery.Conclusion The movable window method,based on the human skin mobility,can be used to facilitate the thoracolumbar vertebral surgery via the multifidus and longissimus approach.