신경학적 증상을 동반한 흉요추 골절에서 후방 유합술: 유합술과 감압술 추가한 군과의 비교 = Posterior Fusion for Thoracolumbar Fractures with a Neurologic Deficit: A Comparison of Fusion and Additional Decompression

다국어 초록 (Multilingual Abstract)

Study Design: A retrospective study.
Objectives: To understand the necessity of additional posterior decompression when treating a patient with posterior fusion for thoracolumbar fractures with a neurologic deficit.
Summary of Literature Review: Additional posterior decompression is still controversial when treating a patient with posterior fusion for thoracolumbar fractures with neurologic a deficit. Materials and Methods: 40 patients who underwent posterior fusion surgery for thoracolumbar fractures with a neurologic deficit were evaluated. The posterior fusion group (Group 1) included 23 patients (M:F=14:9), and the posterior decompression with laminectomy and posterolateral fusion group (Group 2) included 17 patients (M:F=9:8). According to the Frankel grade, the most common neurologic deficit was grade D in both groups. Unstable burst fractures were the most commonly observed fractures in both groups according to the McAfee classification.
A radiographic evaluation was carried out along with a comparison of the spinal canal encroachment and the kyphotic angle. We evaluated neurologic improvement as the clinical criterion.
Results: The l-kyphotic angle at last follow-up was smaller than the preoperative kyphotic angle in both groups. The preoperative canal encroachment was 53.4% (Group 1) and 59.8% (Group 2). Further, neurologic improvement was observed in 19 cases (Group 1) and 14 cases (Group 2). There was no significant difference in the proportion of cases with neurologic improvement between the two groups (improvement in 19 cases in Group 1 and in 14 cases in Group 2) (p<0.05). Further, the preoperative canal encroachment, kyphotic angle, and final neurologic improvement showed no significant correlations between the two groups (p>0.05).
Conclusion: We concluded that additional posterior decompression in the case of thoracolumbar fractures with neurologic deficit is not required for neurologic improvement.

국문 초록 (Abstract)

연구 계획: 후향적 연구.
목적: 신경학적 증상이 있는 흉요추 골절환자에서 후방 유합술을 시행한 군과 추가적인 후방 감압술을 시행한 군을 비교하여 신경 증상의 호전을 위한 추가적인 후방 감압술의 필요성에 대해 알아보고자 하였다.
선행 문헌의 요약: 신경학적 증상이 있는 흉요추 골절환자에서 후방 감압술에 대한 명확한 적응증 및 일치된 의견은 확립되지 않았다.
대상 및 방법: 2004년 1월부터 2012년 6월까지 신경학적 증상을 동반한 흉요추부 골절로 수술적 치료를 시행받은 40예를 대상으로 하였다. 후방 유합술만시행 받은 23(남:여=14:9)예를 제 1군으로, 추가적인 후방 감압술을 시행 받은 17(남:여=9:8)예를 제 2군으로 하였다. 손상 부위는 두 군 모두 요추 1번이 가장많았으며 McAfee분류에 따른 골절 분류상 두 군 모두 불안정성 방출성 골절이 많았다. Frankel 등급에 따른 술 전 신경학적 증상은 등급 D 가 두 군 모두 가장많았다. 방사선학적 평가는 수상 당시와 술 후, 최종 추시때의 척추관 함입률과 후만각의 변화를 측정하였고 임상적 평가는 신경학적 호전 정도를 평가하였다.
결과: 후만각의 변화는 술전에 비해 최종 추시시 두 군 모두 호전되었으며 척추관 함입률은 제 1군에서 술전 53.4%, 제 2군에서 술전 59.8%였다. 최종 추시때 제 1군에서 신경 증상의 호전 19예, 제 2군에서 신경 증상의 호전 14예로 두 군간에 의의 있는 신경학적 호전의 차이는 없었다. 하지만 두 군에 따른 척추관 함입률 및 후만각의 변화와 최종 신경학적 증상 호전과의 상관 관계는 없었다(p>0.05).
결론: 신경학적 증상을 동반한 흉요추 골절에서 신경학적 호전을 위한 추가적인 후방 감압술은 반드시 필요한 술식은 아니라고 사료된다.

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