椎弓根螺钉内固定治疗胸腰椎骨折的疗效分析  

Analysis of curative effect of thoracolumbar fractures treated by internal fixation of pedicle of vertebral arch screws

作　　者：李建生[1] 黎文武[1] 蔡玉明[1] 李志毅[1] 廖育军 

机构地区：[1]广州市白云区人民医院骨科,510500

出　　处：《岭南现代临床外科》2006年第3期204-206,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨椎弓根螺钉内固定治疗胸腰段骨折的疗效,分析椎弓根螺钉断裂、弯曲的原因。方法对我科自1993年7月～1999年10月收治的36例资料完整的胸腰椎骨折采用椎弓根螺钉内固定术进行回顾性分析。结果(1)22例术前有神经损伤症状,术后神经功能恢复,按Frankel分级1级或以上者20例(占91%),2例完全性脊髓损伤者无恢复。腰痛按Denis分级:P124例;P28例;P33例;P41例。(2)伤椎前缘高度术后平均矫正29%,伤椎后缘高度术后平均矫正23%。伤椎高度矫正后至未次复查时平均丢失8%(6～10%)。脊柱CobbIs角平均矫正16.7°,至末次复查时脊柱CobbIs角平均矫正度丢失了3°。(3)椎弓根螺钉断裂4例(5颗钉),螺钉弯曲2例,螺钉松动撬起2例,螺帽脱落1例。结论规范椎弓根螺钉内固定技术治疗胸腰椎骨折,充分植骨融合,恢复伤椎高度,保持和重建脊柱稳定性,有利于神经功能恢复,减少术后并发症的发生。Objective To evaluate the results of thoracolumbar fractures treated with internal fixation of pedicle of vertebral arch screw and to analyse the causes of screws loosened and broken. Methods From July 1993 to October 1999,36 cases with thoracolumbar fractures received fixation of pedicle of vertebral arch screw were analyzed retrospectively. Results （1）22 cases had nervous injury before operation. Postoperative nervous fanctional recovery was 20 cases according to Frankel classification grade I or over grade I （91%）. No recovery of complete spinal cord injury was in 2 cases. Lumbago according to Denis classification was as follows ：P1 24 cases, P2 8cases, P3 3cases,P4 1 case. （2）Postoperative average correction of wounded vertebral body anterior rim highness was 29%, posterior rim was 23%. Average loss was 8%（6-10%）after correction of wounded spine highness to lastime of re-examination. Average correction was 16.7° in the Cobb＇s angle of spine. Average correction of loss was 3% in the Cobb＇s angle of spine during the last time re-examination.（3）Bhoken of padicle of vertebrol arch scrcw was 4 cases （5 nails）, curve of screw was 2 cases, screw loosened was 2 cases, scaling of screw cup 1 case. Conclusion It is very important to standard of internal fixation of padicle of vertebrol arch,enough bone graft and fusion,recovery of wounded spine highness, vertebral stability of keeping and reconstructing for the treatment of thoracolumbar fractures and it can contribute to recovery of neural function and reduce postoperative complication.

关 键 词：胸腰椎骨折 内固定器 疗效分析 

分 类 号：R687.3[医药卫生—骨科学]