应用伤椎置钉技术治疗胸腰椎骨折的生物力学研究与临床应用  

The biomechanical and clinical study of the injuried vertebra transpedicular fixation technique in the treatment of thoracolumbar fractures

作　　者：昌耘冰[1] 范志丹[2] 夏虹[2] 郑秋坚[1] 肖立军[3] 廖穗祥[3] 

机构地区：[1]广东省医学科学院,广东省人民医院骨科,广州510080 [2]广州军区广州总医院骨科医院,广州510010 [3]广州市番禺区人民医院骨科,广州511400

出　　处：《中国临床解剖学杂志》2009年第3期347-350,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省科技厅科技计划项目(2008B080701048)

摘　　要：目的：通过生物力学测试和临床应用对伤椎置钉技术治疗胸腰椎骨折进行评价。方法：6具新鲜冰冻家猪胸腰椎标本T14—L3节段制备成胸腰椎前中柱损伤模型。比较传统短节段4钉法固定和伤椎置钉6钉法固定的三维6个方向的运动范围。临床应用伤椎置钉技术治疗胸腰椎骨折41例，观察该方法的即时复位效果。结果：伤椎置钉法固定后的脊柱标本在前屈、后伸、侧屈状态下的运动范围均小于对照组和四钉法固定组（P〈0．01）。两种固定方法的旋转运动范围均高于对照组（P〈0．01），但六钉法明显小于四钉法固定组（P〈0．01）。41例患者术前Cobb角14-37°，平均23．4°，术后-3～5°，平均-2．3°。术前椎体前缘高度为正常的33．7%-67．2％，平均60．8％。术后高度87．9％-98．7％，平均94．3％。结论：伤椎置钉技术可以提供明显高于传统4钉法固定的即时稳定性，并对某些类型的新鲜胸腰椎骨折的具有良好的即时复位效果。Objective： To investigate the biomechanical stability and the clinical efficacy of reduction of the injured vertebra transpedicular fixation technique in the treatment of thoracolumbar fractures. Methods： 6 thoracolumbar fracture models were made on fresh pig thoracolumbar spine specimens to compare the stability of the injured vertebra transpedicular fixation technique （6-screws construct） with traditional shorter segment fixation（4-screw construct） by examining the range of motion（ROM） in flexion, extension, lateral bending, and torsion. 41 cases of type A, type B1 and type B2 （Magerl-Harms-Gertzbein classification） thoracolumbar fractures was treated surgically within one week by using this technique. Four screws were put in the upper and lower pedicles near the injured vertebra, and one or two shorter screws were inserted into the fractured vertebra to reinforce the reduction and fixation. Results： The 6-screw construct exhibited a smaller ROM significantly in flexion, extension and lateral bending compared with the intact specimens and 4-screw construct （P〈0.01）; the ROM in torsion of 6-screw and 4-screw constructs was larger than that of the intact specimens （P〈0.01）. The Cobb angles of 41 cases was 14-37°, averagely 23.4° preoperatively and -3--5°, averagely -2.3° postoperatively. The height of the anterior border of vertebra was the 33.7%-67.2% of normal ones, averagely 60.8 % preoperatively, and the 87.9%-98.7% of normal ones, averagely 94.3% postoperatively. Conclusions： The application of the additional pedicle screws in the injured vertebrae enhances the biomechanical stability of the short-segment pedicle fixation system. This procedure is also effective for reduction of the fracture and dislocation in the treatment of some type of thoracolumbar fractures.

关 键 词：胸腰椎骨折 伤椎置钉 复位 生物力学 

分 类 号：R683.2[医药卫生—骨科学]