胸腰椎损伤患者应用AF椎弓根钉系统后椎体高度及Cobb角的变化  

Changes of vertebral height and Cobb angle after treatment of AF pedicle of vertebral arch nail system in patients with thoracolumbar fracture and dislocation

作　　者：温曙荣 闵闽 周初松[3] 刘健[3] 

机构地区：[1]南海市罗村人民医院骨科,广东省南海市528226 [2]广州市白云区太和镇医院外科,广东省广州市510540 [3]南方医科大学附属珠江医院骨科,广东省广州市510282

出　　处：《中国临床康复》2005年第46期69-71,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察应用AF椎弓根钉系统复位固定加植骨融合治疗胸腰椎骨折脱位恢复伤椎高度纠正成角畸形的效应。方法:选取1997-07/2004-06南海市罗村人民医院骨科、广州市白云区太和镇医院外科、南方医科大学附属珠江医院骨科收治的外伤性胸腰段椎骨骨折患者117例。患者麻醉后常规植入AF椎弓根钉系统复位固定,如无神经损伤直接取自体髂骨或同种异体骨行后路植骨融合术。若有神经损伤,则先行椎板开窗探查,若骨折块已复位,同上行后路植骨融合。骨折块未复位或复位不理想,则需进一步减压;若经AF椎弓根钉系统复位固定后仍有明显压迫,则需通过咬除一侧椎弓根行骨折脊椎次环状减压术。对减压后缺损较大者,同时行椎间融合加椎体内植骨,对骨折脱位者从后路经椎管行椎间植骨融合术。测量术前、术后及术后1年伤椎椎体高度百分比及Cobb角的变化。结果:按意向处理分析,实验纳入外伤性胸腰段脊柱骨折患者117例,全部完成1年随访而进入结果分析。与术前比较,全部患者的椎高百分比于术后即刻、术后1年均明显提高[(58.32±7.82),(96.14±9.46),(92.65±10.48)%,P均<0.01],Cobb角均明显降低[(15.58±5.68),(4.26±2.85),(5.47±2.24)°,P均<0.01]。结论:AF椎弓根钉系统复位力强,可有效恢复伤椎椎体的高度并纠正成角畸形,提示在良好复位基础上的坚强固定与确实有效的植骨融合是取得理想效果的根本所在。AIM： To observe the effect on the recovery of the height of damaged vertebrae and correction of angulated deformity by AF pedicle of vertebral arch nail system reduce fixation and implant fusion in thoracolumbar fracture and dislocation. METHODS： Totally 117 patients with traumatic thoracolumbar fracture were selected from the Department of Orthopaedics, Luocun People＇s Hospital of Nanhai City, the Department of Surgery, Baiyun District Taihe Town Hospital of Guangzou City and the Department of Orthopaedics, Zhujiang Hospital affiliated to Southern Medical University between July 1997 and June 2004. The patients were treated by routine implant of AF pedicle of vertebral arch nail system reduce fixation after anesthesia. If there was no nerve injury, autologous iliac bone or allogeneic bone were fetched directly for posterior fusion of grafted bone. If there were never injuries, exploration by fenestration of vertebral lamina was conducted firstly, and then if the fracture block was reduced, the posterior fusion of grafted bone was performed as above; if the fracture block was not reduced or the reduce was no satisfactory, further decompression was needed. If there was still obvious compression after AF pedicle of vertebral arch nail system reduce fixation, secondary annular decompression of fractured vertebra was conducted by biting out one lateral pedicle of vertebral arch. For those with greater defect after decompression, interbedy fusion and intrapyramidal implant were performed at the same time. For those with fracture dislocation, interbody fusion of grafted bone was conducted from posterior through vertebral canal. The percentage of damaged vertebral height and change of Cobb angle were measured before and after operation as well as 1 year after operation. RESULTS： According to intention-to-treat analysis, 171 patients with traumatic thoracolumbar fracture were involved, all of them finished the 1year follow-up and entered the analysis of results. As compared with before operation, the percentag

关 键 词：胸椎/损伤 腰椎/损伤 骨折固定术 内 脊柱骨折/外科学 

分 类 号：R683.2[医药卫生—骨科学]