摘要
目的探讨长节段内固定治疗胸腰椎骨折术后失败的原因,并重点分析脊柱力线失衡与内固定手术失败的关系。方法回顾性分析2004年1月至2015年1月,南方医科大学南方医院收治的胸腰椎骨折病例70例,其中男41例,女29例,年龄18~57岁,平均年龄(33.6±10.4)岁,均行后路长节段固定。AOSpine骨折分型均为A3、A4、B、C型等不稳定骨折。统计两组患者骨折节段及AO骨折分型,并比较两组患者伤椎移位距离(distance of the fractured vertebra shifting,DFVS)、脊柱侧(后)凸Cobb’s角。依据术后脊柱冠状位及矢状位力线恢复的情况,将患者分为力线良好组(A组)和力线失衡组(B组),分析两组患者脊柱力线失衡与内固定失败的情况,并探讨两者的关系。结果本组70例中,力线良好组49例,力线失衡组21例,其中矢状位力线失衡9例,冠状位力线失衡7例,矢状位力线合并冠状位力线失衡5例。组内比较:A组患者手术前、后伤椎移位距离分别为(11.1±7.1)mm和(0.9±1.3)mm,脊柱侧凸Cobb’s角分别为(6.3±7.3)°和(1.0±1.3)°,脊柱后凸Cobb’s角分别为(16.2±9.9)°和(7.9±8.2)°,差异均有统计学意义(P<0.001)。B组患者手术前、后伤椎移位距离分别为(9.2±6.0)mm和(4.2±3.6)mm,脊柱后凸Cobb’s角分别为(17.8±9.5)°和(7.7±7.1)°,差异有统计学意义(P=0.001);而脊柱侧凸Cobb’s角无统计学意义(P>0.05)。组间比较:两组患者术前伤椎移位距离、脊柱侧(后)凸Cobb’s角的差异无统计学意义(P>0.05)。术后1周,A、B两组患者伤椎移位距离和脊柱侧凸Cobb’s角的差异均有统计学意义(P<0.001)。末次随访时,A、B两组患者伤椎移位距离分别为(0.8±1.4)mm和(4.2±3.9)mm,脊柱侧凸Cobb’s角分别为(0.9±1.2)°和(4.2±6.1)°,差异有统计学意义(P<0.001)。结论导致胸腰椎骨折长节段内固定术后失败的原因有很多,其中脊柱冠状位及矢状位力线失衡是导致内固定失败的重要因素。在骨折复位过程中,应尽可能恢复脊柱力线平衡,减少内固定手术失败的风险。
Objective To analyze the reasons of implant failure after posterior long-segment instrumentation for thoracolumbar fracture, and to discuss the relationship between the imbalance of the spinal alignment and implant failure. Methods From January 2004 to January 2015, 70 patients with unstable thoracolumbar fracture were treated with posterior long-segment fixation in Nanfang Hospital, Southern Medical University. There were 41 males and 29 females with the mean age of（ 33.6 ± 10.4） years（ range： 18-57 years）. AO Spine fracture classification： type A3, A4, B and C. Fracture segments and AO fracture classification results were compared between the 2 groups. The distance of fractured vertebra shifting（ DFVS）, scoliosis and kyphotic Cobb＇s angle were measured on X-ray radiographs pre and post operatively. According to the spine coronal and sagittal alignment after the operation, we divided all patients into balanced group（ Group A, n = 49） and unbalanced group（ Group B, n = 21, 9 cases with the imbalanced sagittal alignment, 7 cases with the imbalanced coronal alignment, 5 cases with the imbalanced sagittal and coronal alignment）. The relationship between the unbalanced spine alignment and internal fixation failure was discussed. Results There were significant differences pre and post operation in DFVS [（ 11.1 ± 7.1） mm vs.（ 0.9 ± 1.3） mm ], scoliosis Cobb＇s angle [（ 6.3 ± 7.3） ° vs.（ 1.0 ± 1.3） ° ] and kyphotic Cobb＇s angle [（ 16.2 ± 9.9） ° vs.（ 7.9 ± 8.2） ° ] in Group A（ P〈0.001）. There were also significant differences pre and post operation in DFVS [（ 9.2 ± 6.0） mm vs.（ 4.2 ± 3.6） mm ] and kyphotic Cobb＇s angle [（ 17.8 ± 9.5） ° vs.（ 7.7 ± 7.1） ° ] in Group B（ P = 0.001）. But scoliosis Cobb＇s angle showed no differences in Group B. There were no significant differences in DFVS, scoliosis and kyphotic Cobb＇s angle between the 2 groups before the surgery（ P〈0.05）. There were significant differences in DFVS and scoliosis Cobb＇s angle between the 2 groups 1 week after the surgery（ P 0.001）. There were significant differences in DFVS [（ 0.8 ± 1.4） mm vs.（ 4.2 ± 3.9） mm ] and scoliosis Cobb＇s angle [（ 0.9 ± 1.2） ° vs.（ 4.2 ± 6.1） ° ] between Group A and B at the final follow-up（ P〈0.001）. Conclusions There are many reasons for implant failure after posterior long-segment instrumentation. The imbalance of coronal and sagittal alignment is an important factor leading to the failure of the internal fixation. In the process of fracture reduction, we should try to restore the balance of the spine alignment to reduce the risk of implant failure.
作者
陈永和
王翔
瞿东滨
江建明
CHEN Yong-he, WANG Xiang, QU Dong-bin, JIANG Jian-ming(Department of Orthopaedics, Xintang Hospital, Zengcheng District, Guangzhou, Guangdong, 511340, Chin)
出处
《中国骨与关节杂志》
CAS
2018年第3期219-224,共6页
Chinese Journal of Bone and Joint
关键词
脊柱骨折
胸椎
腰椎
骨折固定术
内
脊柱力线
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Fracture fixation, internal
Spinalalignment
