CAJ | 학술논문

背景：传统修复单椎体胸腰椎骨折常采用跨伤椎4钉固定，由于存在“平行四边形效应”及“悬挂效应”，容易发生内固定失败，复位高度及矫正角度丢失等并发症，而经伤椎椎弓根钉内固定，可避免或减少上述并发症发生。目的：探讨经伤椎椎弓根螺钉置入内固定修复单椎体胸腰椎骨折的可行性。方法：回顾性分析兰州大学第一医院骨科2013年1月至2014年6月收治的单节段胸腰椎骨折患者23例，损伤节段为T11-L2，平均年龄47.8岁，所有患者均在受伤后10 d内接受后路伤椎椎弓根螺钉和相邻上下椎椎弓根螺钉6枚螺钉内固定治疗，观察修复效果，包括术后短期并发症、椎体前缘高度比值及后凸Cobb角，以及脊髓神经功能损伤恢复情况。结果与结论：23例患者随访4-15个月，所有病例治疗后短期内(4-15个月)均未出现严重并发症，末次随访未出现钉棒断裂及内固定松动等情况。治疗后及末次随访所测得椎体前缘高度比值及后凸 Cobb 角均较治疗前明显改善，差异有显著性意义(P <0.05)，两项指标末次随访与治疗后相比稍有反弹，但差异无显著性意义(P >0.05)。末次随访时大部分患者脊髓神经功能有所恢复。提示经伤椎椎弓根螺钉置入内固定修复单节段胸腰椎骨折，能够有效恢复伤椎高度及矫正后凸畸形，并能保持矫正效果，钉棒断裂发生率低，优势明显。
배경：전통수복단추체흉요추골절상채용과상추4정고정，유우존재“평행사변형효응”급“현괘효응”，용역발생내고정실패，복위고도급교정각도주실등병발증，이경상추추궁근정내고정，가피면혹감소상술병발증발생。목적：탐토경상추추궁근라정치입내고정수복단추체흉요추골절적가행성。방법：회고성분석란주대학제일의원골과2013년1월지2014년6월수치적단절단흉요추골절환자23례，손상절단위T11-L2，평균년령47.8세，소유환자균재수상후10 d내접수후로상추추궁근라정화상린상하추추궁근라정6매라정내고정치료，관찰수복효과，포괄술후단기병발증、추체전연고도비치급후철Cobb각，이급척수신경공능손상회복정황。결과여결론：23례환자수방4-15개월，소유병례치료후단기내(4-15개월)균미출현엄중병발증，말차수방미출현정봉단렬급내고정송동등정황。치료후급말차수방소측득추체전연고도비치급후철 Cobb 각균교치료전명현개선，차이유현저성의의(P <0.05)，량항지표말차수방여치료후상비초유반탄，단차이무현저성의의(P >0.05)。말차수방시대부분환자척수신경공능유소회복。제시경상추추궁근라정치입내고정수복단절단흉요추골절，능구유효회복상추고도급교정후철기형，병능보지교정효과，정봉단렬발생솔저，우세명현。
BACKGROUND:Traditionaly repairing single vertebral thoracolumbar fracture often uses of cross-vertebral 4 screw fixation. Because of “paralelogram effect” and the “suspension effect”, it is prone to have internal fixation failure, reset height and correction angle loss, and other complications. However, these complications can be avoided or reduced by fractured vertebra pedicle screw fixation. OBJECTIVE:To investigate the feasibility evaluation of pedicle screw fixation for repairing thoracolumbar fracturevia fractured vertebrae. METHODS:A total of 23 patients with single segment thoracolumbar fractures treated at the First Hospital of Lanzhou University between January 2013 and June 2014 were retrospectively analyzed. The fractured segments were between T11 to L2, the patient’s average age was 47.8 years old. Al the patients received the posterior pedicle screws and adjacent and up and down six pedicle screw internal fixation within 10 days after injury. The repair effect was observed, including short-term postoperative complications, vertebral height ratio, Cobb angle and the recovery of spinal neurological function. RESULTS AND CONCLUSION:Twenty-three cases were folowed up for 4 to 15 months. Al patients had no severe complications in the short term (4 to 15 months) after treatment. There was no screw rod breakage or internal fixation loosening at the last folow-up. The vertebral height ratios and Cobb angle which were measured in postoperative and final folow-up were significantly improved compared with the preoperative data (P < 0.05). The two indicators had a slight rebound in the last folow-up compared with that after treatment, but the difference was not significant (P> 0.05). The spinal neurological functions of most patients were partialy recovered at the last folow-up. These results suggest that pedicle screw embedding fixation repairing thoracolumbar fractureviafractured vertebrae can effectively restore vertebral height and correct kyphosis, and maintain correction effect. The advantages are obvious with a low occurrence rate of pedicle screw fracture.