摘要
目的比较经伤椎与不经伤椎椎弓根螺钉复位固定治疗胸腰椎骨折的临床效果。方法回顾性研究2006年3月-2008年2月收治的胸腰椎单一椎体骨折患者27例，其中12例采用骨折椎加用椎弓根螺钉固定（A组），15例采用传统双平面固定（B组）。A组男9例，女3例，平均年龄43岁（25～56岁）；B组男10例，女5例，平均年龄42岁（23～61岁）。所有患者均为新鲜骨折并且骨折椎一侧或双侧椎弓根完整。所有患者均于麻醉状态下行体位复位，B组行后路常规伤椎上下椎体椎弓根螺钉置人复位固定；A组在B组方法基础上加用伤椎椎弓根螺钉置入复位固定。观测患者后凸畸形（Cobb角）及伤椎高度恢复情况。结果术后随访5～22个月，平均9个月。经伤椎椎弓根螺钉使骨折椎向腹侧移动复位，术后Cobb角及前柱高度恢复较佳。手术前后骨折椎前移复位程度的变化：A组为0．089±0．036，B组为0．023±0．048（P〈0．001）；两组Cobb角的变化：A组为（9．88±7．69）°，B组为（5．19±3．24）°（P〈0．05）；伤椎前柱高度的变化：A组为（39．3±5．2）％，B组为（20．6±6．5）％（P〈0．05）。骨折椎加用椎弓根螺钉在前柱撑开的同时可有效控制正常椎间盘高度的撑开。结论对胸腰椎单一椎体骨折有条件地应用伤椎椎弓根螺钉有利于矫正后凸畸形和恢复伤椎前缘高度，并且增强胸腰椎骨折后路短节段内固定系统的牢固性和维持矫正效果。
Objective To compare the clinical curative effect of pedicle screw reduction and fixation via or not the injured vertebra in treatment of thoracolumbar fractures. Methods A retrospective study was performed on 27 patients with single thoracolumbar fractures admitted from March 2006 to February 2008. There were 12 patients treated with pedicle screw fixation （ Group A） and 15 with traditional two-level fixation （Group B）. Group A involved 11 males and 5 females, aged average 43 years （25-56 years） ; Group B included 10 males and 5 females, aged from 23 to 61 years （mean 42 years）. All patients had fresh fractures with intact pedicles on either unilateral or bilateral sides. With body position reduction under anesthesia, the patients in Group B were treated with posterior routine distraction and lordosis restoration, while those in Group A were treated with the methods used in Group B as well as pedicle screw reduction and fixation. The kyphosis （Cobb angle） and recovery of injured vertebral height were observed. Results The mean follow-up period was 9 months （6-22 months）. After operation, the optimal Cobb angle and anterior column restoration were achieved through the ventral reduction from the injured vertebral body. The degree in anterior movement of injured vertebrae pre- and post-operatively was （0. 089 ±0. 036 ） ° in Group A and （ 0. 023 ±0. 048 ）° in Group B, with statistical difference （P 〈 0.01 ）. Cobb angle was （9.88 ±7.69 ）° in Group A and （5.19 ± 3.24）° in Group B （P 〈 0.05 ）. Changes of distance between the anterior- upper edge of the cephalad vertebrae to the anterior- lower edge of the caudal vertebral body was （39.3 ±5.2） % in Group A and （ 20. 6 ±6.5 ） % in Group B （ P 〈 0. 05 ）. Over distraction of the contiguous discs was also avoided efficiently. Conclusions Selective pedicle screw fixation into the injured vertebrae can help correct the kyphosis and maintain the reduction and enhance the stiffness of the posterior short-segment instrumentation in single thoracolumbar fractures.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2009年第8期694-697,共4页
Chinese Journal of Trauma
关键词
脊柱骨折
胸椎
腰椎
螺钉
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Screws
