부하분담점수 7점 이상인 흉요추부 방출성 골절에서 단분절 및 장분절 후방 고정술의 결과 = The Outcomes of Short and Long Segment Posterior Instrumentation of Thoracolumbar Burst Fractures with a Load Sharing Score of 7 or More

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective.
Objectives: To investigate outcomes between short and long segment posterior instrumentation of thoracolumbar burst fractures with a load sharing score of 7 or more.
Summary of Literature Review: Short segment instrumentation has been recommended in thoracolumbar burst fractures with a load sharing score of 6 or less, and long segment instrumentation has been recommended for those with a score of 7 or more. However, this standard is controversial.
Materials and Methods: From March 2006 to January 2014, 45 patients with thoracolumbar fractures with a load sharing score of 7 or more were treated with posterior instrumentation. They were divided into two groups: short (group S) and long segment (group L) groups.
Radiologic results were evaluated on the basis of the kyphotic angle and anterior column height. Complications were also reviewed.
Results: Groups S and L consisted of 13 and 32 patients and had mean ages of 48.3 and 47.3 years, respectively. In group S, the anterior column height increased from 56.62% to 76.23% postoperatively, and remained at 71.15% at follow-up. The kyphotic angle decreased from 16.27° to 7.55° postoperatively, and was 13.17° at follow-up. In group L, the anterior column height recovered from 49.67% to 70.52% postoperatively, and was 63.73% at follow-up. The kyphotic angle decreased from 20.08° to 6.80° postoperatively, and was 14.18° at follow-up. The changes in the anterior column height and kyphotic angle were not significantly different between groups S and L.
Seven cases had complications and the number of cases with complications was not significantly different between groups S and L.
Conclusions: Short and long segment instrumentation of thoracolumbar fractures with a load sharing score of 7 or more did not achieve significantly different results.

국문 초록 (Abstract)

연구 계획: 후향적 연구.
목적: 부하분담점수 7점 이상인 흉요추부 방출성 골절 환자에서의 단분절 및 장분절 후방고정술의 결과를 알아보고자 한다.
선행 문헌의 요약: 흉요추부 방출성 골절에서 부하분담점수 6점 이하의 경우 단분절 후방고정술이, 7점 이상의 경우 장분절 고정술이 추천된다. 그러나, 적정 고정 범위에 대한 논란의 여지가 있다.
대상 및 방법: 2006년 3월부터 2014년 1월까지 부하분담점수 7점 이상의 흉요추부 방출성 골절로 후방고정술을 시행한 45명의 환자를 단분절 고정술을 시행한 경우를 S(short)군, 장분절 고정술을 시행한 경우를 L(long)군으로 분류하였다. 영상의학적 결과로 술후 및 추시시 전방추체높이, 척추 후만각의 변화를 조사하였으며, 술후 합병증을 조사하였다.
결과: 부하분담점수 7점 이상인 환자 45명중 S군이 13명, L군이 32명이었고 평균 나이는 각각 48.3(28-67)세, 47.3(22-75)세였다. S군의 술전 전방 추체 높이는 평균 56.62±11.72%였으며, 술후 평균 76.23±11.25%로 회복을 보였고, 최종 추시상 71.15±14.58%로 측정되었다. 척추 후만각은 술전16.27±5.93도에서 술후 7.55±5.25도, 최종 추시상 13.17±7.74도로 확인되었다. L군의 전방 추체 높이는 술전 49.67±18.66%에서 술후 평균 70.52 ±18.58%로 회복을 보였고, 최종 추시상 63.73±21.46%로 나타났으며, 척추 후만각은 20.08±7.27도에서 술후 평균 6.80±5.36도, 최종 추시상14.18±10.89도로 나타났다. 술후와 최종 추시시 전방 추체 높이와 척추 후만각의 변화량은 두 군간 유의한 차이를 보이지 않았다(p=0.669, p=0.354).
나사못 이완, 기기 실패, 불유합 등의 합병증을 보인 환자는 7명(S군 1명(7.6%), L군 6명(22.2%))으로 L군이 더 많으나 통계적으로 유의하지 않았다(p=0.065).
결론: 흉요추부 방출성 골절이 있는 부하분담점수 7점 이상의 환자에서 단분절, 장분절 고정술시 술후 정복 소실 정도와 합병증률에서 유의한 차이가없었다.

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