CAJ | 학술논문

目的：探讨后路椎弓根钉内固定、前路减压植骨术分期治疗合并多发伤的胸腰椎爆裂性骨折的临床疗效。方法回顾性分析53例行分期后前路手术治疗的单节段胸腰椎爆裂性骨折患者，比较术前及末次随访时伤椎压缩高度比、Cobb 角及椎管容积，应用 Frankel 评分评估神经功能恢复情况，Fugl-Meyer 评分评价运动功能的改善。结果共有49例患者获得随访。末次随访时，患者的伤椎压缩高度比、Cobb 角及椎管容积均较术前明显改善（t ＝24．047，P ＜0．01；t ＝21．815，P ＜0．01；t ＝31．699，P ＜0．01）。术前，Frankel 分级为：A 级6例，B 级18例，C 级15例，D 级10例，E 级4例；末次随访时，分别为3例、8例、11例、17例和10例，治疗后神经功能评分较前明显改善（Z ＝2．997，P ＝0．003）。治疗前，Fugl-Meyer 平均分为（74．65±8.42）分，末次随访时为（90．26±9．17）分，术后患者的运动功能评分明显升高（t ＝8．963，P ＜0．01）。结论Ⅰ期行后路椎弓根钉内固定，Ⅱ期行前路减压植骨术治疗合并多发伤的胸腰椎爆裂性骨折，临床疗效确切，有利于运动和脊髓功能的恢复。
목적：탐토후로추궁근정내고정、전로감압식골술분기치료합병다발상적흉요추폭렬성골절적림상료효。방법회고성분석53례행분기후전로수술치료적단절단흉요추폭렬성골절환자，비교술전급말차수방시상추압축고도비、Cobb 각급추관용적，응용 Frankel 평분평고신경공능회복정황，Fugl-Meyer 평분평개운동공능적개선。결과공유49례환자획득수방。말차수방시，환자적상추압축고도비、Cobb 각급추관용적균교술전명현개선（t ＝24．047，P ＜0．01；t ＝21．815，P ＜0．01；t ＝31．699，P ＜0．01）。술전，Frankel 분급위：A 급6례，B 급18례，C 급15례，D 급10례，E 급4례；말차수방시，분별위3례、8례、11례、17례화10례，치료후신경공능평분교전명현개선（Z ＝2．997，P ＝0．003）。치료전，Fugl-Meyer 평균분위（74．65±8.42）분，말차수방시위（90．26±9．17）분，술후환자적운동공능평분명현승고（t ＝8．963，P ＜0．01）。결론Ⅰ기행후로추궁근정내고정，Ⅱ기행전로감압식골술치료합병다발상적흉요추폭렬성골절，림상료효학절，유리우운동화척수공능적회복。
Objective To investigate the clinical effect of posterior pedicle screw fixation combined with anterior decompression and fusion for the treatment of thoracolumbar burst fractures.Methods The clinical data of 53 patients underwent posterior pedicle screw fixation and anterior decompression and fusion were retrospectively analyzed.The vertebral height,Cobb angle,vertebral tube volume,the Frankel gradient and Fugl -Meyer score were recorded and compared before and after treatment.Results 49 patients were followed up.At the last time of follow -up,the vertebral height,Cobb angle,vertebral tube volume all significantly improved (t =24.047,P <0.001;t =21.815,P <0.001;t =31.699,P <0.001).The Frankel gradient before treatment was:A 6 cases,B 18 cases,C 15 cases,D 10 cases,E 4 cases.After treatment,it came to 3 cases,8 cases,11 cases,17 cases,10 cases,respectively.There was significant difference before and after treatment (Z =2.997,P =0.003).There was significant difference in Fugl -Meyer score before and after treatment[(74.65 ±8.42)points,(90.26 ±9.17)points,respectively,P <0.001 ].Conclusion There is excellent effect on posterior pedicle screw fixation followed by anterior decompression and fusion for the treatment of thoracolumbar burst fractures.It is good for the recovery of motion and spinal function.