CAJ | 학술논문

目的：：探讨半椎板切除减压、撬拨复位伤椎体内植骨治疗严重胸腰椎爆裂骨折的临床疗效。方法：对32例严重胸腰椎爆裂骨折行椎弓根螺钉内固定、半椎板切除减压、撬拨复位伤椎体内植骨治疗。采用Frankel神经功能分级评价术后神经功能恢复情况评价脊髓及马尾神经功能改善情况。通过手术前后摄X线片测量骨折椎体相对高度、Cobb 角及CT测量椎管内骨折块占位率情况评价骨折愈合及椎管减压情况。结果：手术时间120~190 min,平均150.4 min；术中出血量200~500 mL,平均340 mL；术后1年伤椎体水平椎管狭窄率明显降低,狭窄程度明显减轻(P＜0.01)；术后各时间点Cobb 角与术前比较均明显恢复(P＜0.01)；术后各时间点椎体相对高度与术前比较均明显提高(P＜0.01)；30例患者的术后1年Frankel神经功能分级有1~3级改善。结论：半椎板切除减压、撬拨复位伤椎体内植骨治疗严重胸腰椎爆裂骨折临床疗效满意,椎管得到充分减压,椎体内植骨重塑了椎体的形状和高度,伤椎愈合、植骨融合良好,取出内固定后矫正度无明显丢失,是治疗严重胸腰椎爆裂骨折的有效方式。
목적：：탐토반추판절제감압、효발복위상추체내식골치료엄중흉요추폭렬골절적림상료효。방법：대32례엄중흉요추폭렬골절행추궁근라정내고정、반추판절제감압、효발복위상추체내식골치료。채용Frankel신경공능분급평개술후신경공능회복정황평개척수급마미신경공능개선정황。통과수술전후섭X선편측량골절추체상대고도、Cobb 각급CT측량추관내골절괴점위솔정황평개골절유합급추관감압정황。결과：수술시간120~190 min,평균150.4 min；술중출혈량200~500 mL,평균340 mL；술후1년상추체수평추관협착솔명현강저,협착정도명현감경(P＜0.01)；술후각시간점Cobb 각여술전비교균명현회복(P＜0.01)；술후각시간점추체상대고도여술전비교균명현제고(P＜0.01)；30례환자적술후1년Frankel신경공능분급유1~3급개선。결론：반추판절제감압、효발복위상추체내식골치료엄중흉요추폭렬골절림상료효만의,추관득도충분감압,추체내식골중소료추체적형상화고도,상추유합、식골융합량호,취출내고정후교정도무명현주실,시치료엄중흉요추폭렬골절적유효방식。
Objective:To investigate the therapeutic effect of severe thoracolumbar burst fractures by lateral laminectomy decompression,prying and bone grafting in injured vertebral body. Methods:32 patients with severe thoracolumbar burst fractures were treated by posterior short-segment fixation combined with lateral laminectomy decompression,prying and bone grafting in injured vertebral body. Accorded X - ray film was taken to measure the relative height of fractured vertebrae for evaluating vertebral height restoration. Cobb angle evaluated correction of kyphosis;and Frankel classification was conducted to evaluate the function recovery of the spinal cord. Results:The average surgery time was 150. 4 min(120-190 min) and the average blood loos was 340 mL(200-500 mL). 1 year after operation,showed the space occuping rates of fractureed vertebrae had much better than that before operation (P<0. 01). The Cobb angles were much better than that before operation (P<0. 01). The relative height of fractured vertebrae were much better than that before ( P <0. 01 ) . 30 cases was improved 1 -3 grades in neural function. Conclusion:Treatment of severe thoracolumbar burst fractures by lateral laminectomy decompression,prying and bone grafting in injured vertebral body has satisfactory effectiveness, which can reconstruct vertebral body shape and height with spinal cord decompression. Bone graft healing and bony fusion are much better too.