目的:对比分析在胸腰椎骨折患者中采取经伤椎和跨伤椎椎弓根钉棒系统内固定治疗效果。方法:选取2013年1月—2019年9月我院收治的胸腰椎骨折患者86例,随机分为两组。试验组43例,接受经伤椎椎弓根钉棒系统内固定治疗;对照组43例,接受跨伤...目的:对比分析在胸腰椎骨折患者中采取经伤椎和跨伤椎椎弓根钉棒系统内固定治疗效果。方法:选取2013年1月—2019年9月我院收治的胸腰椎骨折患者86例,随机分为两组。试验组43例,接受经伤椎椎弓根钉棒系统内固定治疗;对照组43例,接受跨伤椎椎弓根钉棒系统内固定治疗,对比两组患者伤椎椎体高度丢失率、伤椎前缘高度、伤椎后凸Cobb角、术中出血量、手术时间等。结果:术前,两组患者伤椎椎体高度丢失率[(60.16±8.85%)、(59.98±8.76%)]差异无统计学意义(P>0.05);术后、末次随访试验组伤椎椎体高度丢失率[(12.87±4.21)%、(13.69±3.63)%]均显著低于对照组[(17.02±5.44)%、(19.11±5.12)%],两组比较差异均有统计学意义(P<0.05);术前、术后,两组患者伤椎前缘高度、伤椎后凸C o b b角差异无统计学意义(P>0.05);末次随访,试验组患者伤椎前缘高度大于对照组,伤椎后凸Cobb角小于对照组,差异具有统计学意义(P<0.05);试验组患者术后畸形复发率、二次手术发生率(2.33%、4.65%)低于对照组(16.28%、20.93%),两组比较差异具有统计学意义(P<0.05);与对照组患者相比,试验组患者的术中出血量、手术时间[(375.43±13.26)mL、(141.38±6.83)min]均明显少于/短于对照组患者[(381.67±12.77)mL、(147.38±5.97)min],两组比较差异均有统计学意义(P<0.05)。结论:与跨伤椎椎弓根钉棒系统内固定治疗相比,在胸腰椎骨折患者中采取经伤椎椎弓根钉棒系统内固定治疗,能够有效矫正患者后凸症状,减少了术后畸形复发率、二次手术发生率等,临床效果更好,值得临床应用。展开更多
Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of ...Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases. Methods： From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied. Results： All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association （JOA） scores ranged from 10（improvement rate=70.10%）. X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants＇ position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed. Conclusions： Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.展开更多
文摘目的:对比分析在胸腰椎骨折患者中采取经伤椎和跨伤椎椎弓根钉棒系统内固定治疗效果。方法:选取2013年1月—2019年9月我院收治的胸腰椎骨折患者86例,随机分为两组。试验组43例,接受经伤椎椎弓根钉棒系统内固定治疗;对照组43例,接受跨伤椎椎弓根钉棒系统内固定治疗,对比两组患者伤椎椎体高度丢失率、伤椎前缘高度、伤椎后凸Cobb角、术中出血量、手术时间等。结果:术前,两组患者伤椎椎体高度丢失率[(60.16±8.85%)、(59.98±8.76%)]差异无统计学意义(P>0.05);术后、末次随访试验组伤椎椎体高度丢失率[(12.87±4.21)%、(13.69±3.63)%]均显著低于对照组[(17.02±5.44)%、(19.11±5.12)%],两组比较差异均有统计学意义(P<0.05);术前、术后,两组患者伤椎前缘高度、伤椎后凸C o b b角差异无统计学意义(P>0.05);末次随访,试验组患者伤椎前缘高度大于对照组,伤椎后凸Cobb角小于对照组,差异具有统计学意义(P<0.05);试验组患者术后畸形复发率、二次手术发生率(2.33%、4.65%)低于对照组(16.28%、20.93%),两组比较差异具有统计学意义(P<0.05);与对照组患者相比,试验组患者的术中出血量、手术时间[(375.43±13.26)mL、(141.38±6.83)min]均明显少于/短于对照组患者[(381.67±12.77)mL、(147.38±5.97)min],两组比较差异均有统计学意义(P<0.05)。结论:与跨伤椎椎弓根钉棒系统内固定治疗相比,在胸腰椎骨折患者中采取经伤椎椎弓根钉棒系统内固定治疗,能够有效矫正患者后凸症状,减少了术后畸形复发率、二次手术发生率等,临床效果更好,值得临床应用。
文摘Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases. Methods： From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied. Results： All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association （JOA） scores ranged from 10（improvement rate=70.10%）. X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants＇ position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed. Conclusions： Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.
