摘要
[目的]通过生物力学测试及长期临床应用对伤椎置钉技术治疗胸腰椎骨折进行综合评价。[方法]6具新鲜冰冻小牛腰椎标本L1-5节段制备成腰椎前中柱损伤模型。比较伤椎置钉6钉固定法和传统短节段4钉固定法的三维6个方向的运动范围及椎间刚度值。临床应用附加伤椎置6钉固定技术及跨伤椎4钉固定技术治疗胸腰椎骨折并随访至内固定取出者分别为15、14例,平均随访时间分别为18.5、17.0个月。长期随访观察其即时复位效果、内固定取出前矫正度丢失情况。[结果]伤椎置钉6钉固定法与跨伤椎4钉固定法标本在屈曲、后伸、侧弯方向的ROM值与完整对照组相比,差异均有显著性意义（P〈0.05）。伤椎置钉6钉固定法与跨伤椎4钉固定法标本在旋转方向的ROM值大于完整对照组,且差异存在显著统计学意义（P〈0.05）。2种固定方式固定术后矢状位后凸Cobb角、椎体前缘高度与术前相比差异有明显统计学意义（P〈0.05）,末次随访时改善度与术后即刻改善度相比差异无统计学意义（P〉0.05）。6钉固定组的伤椎前缘高度在术后及内固定取出前与4钉固定相比,差异存在明显统计学意义（P〈0.05）。[结论]伤椎置钉技术可以明显增加传统4钉法固定各运动方向的即时稳定性,尤其是屈曲、后伸及轴向旋转稳定性。长期临床随访结果示伤椎置钉技术对某些新鲜胸腰椎骨折具有良好的即时复位及保持校正效果的作用。
[Objective]To investigate the biomechanical stability and the long term follow-up clinical efficacy of reduction of the injured vertebra transpedicular fixation technique in the treatment of thoracolumbar fractures.[Method]Six lumbar fracture models were made on fresh calf lumbar spine specimens to compare the stability of the injured vertebra transpedicular fixation technique（6-screw construct）with traditional shorter segment fixation（4-screw construct）by examining the range of motion（ROM）in flexion,extension,lateral bending,and torsion.Fifteen of thoracolumbar fractures was treated surgically within one week by using this technique,14 patients were treated by traditional posterior short segment pedicle screw fixation.They were all followed up till the internal fixation plant were taken out,the mean follow-up time was 18.5 months and 17.0 months.[Result]The 6-screw construct and 4-screw construct exhibited a smaller ROM significantly in flexion,extension and lateral bending compared with the intact specimens（P〈0.05）.The ROM in torsion of 6-screw and 4-screw constructs was larger than that of the intact specimens（P〈0.05）.There were significant differences in the ROM of flexion,extension and torsion between the 6-screw construct and the 4-screw construct（P〈0.05）.There were significant differences in the Cobbs angle and the anterior height of the fractured vertebra between preoperative and postoperative（P〈0.05）.No significant differences were found between postoperative and the last follow-up（P〉0.05）.The Cobbs angle and the anterior height of the fractured vertebra between the 6-screw and the 4-screw construct were significantly different in postoperative and the last follow-up time（P〈0.05）.[Conclusion]The application of additional pedicle screws fixation in the injured vertebrae enhances the biomechanical stability of the short-segment pedicle fixation system especially in the flexion,extension and torsion.This procedure is also effective for reduction of the fracture and can decrease the reduction loss in the treatment of some type of thoracolumbar fractures through the long-term follow-up clinical study.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第16期1356-1360,共5页
Orthopedic Journal of China
基金
军队临床高新技术重大项目(编号:2010gxjs072)
关键词
胸腰椎骨折
椎弓根螺钉
伤椎固定
生物力学
thoracolumbar fracture
pedicular screw
fixation of the fractured vertebra
biomechanics
