RF内固定器治疗胸腰椎爆裂性骨折中、远期疗效分析  

Mid-and Long-term Follow-up Study of Thoracolumbar Burst Fractures Treated with RF Pedicle Instrumentation

作　　者：王子平 陆耀刚 吴佩蓉 

机构地区：[1]上海市南汇区周浦医院骨科,201318

出　　处：《中国骨与关节损伤杂志》2009年第8期691-694,共4页Chinese Journal of Bone and Joint Injury

基　　金：上海市卫生局科研课题(05II022 2-1)

摘　　要：目的探讨经后路短节段RF内固定治疗胸腰椎爆裂性骨折的中、远期疗效。方法对经后路切开复位RF-I型内固定器手术治疗胸腰椎单节段爆裂性骨折142例资料进行分析。结果术前存在脊髓不完全损伤27例,术后25例完全恢复。腰痛Denis评分:P1 106例,P2 36例。功能活动按Christian评分:3分2例,4分6例,5分34例,6分63例,7分37例。满意度患者自我测评,非常满意102例,满意40例。X线检查伤后、术后、随访时情况:椎体前高分别为51.8%、97.2%、95.6%;椎体后高92.0%、99.2%、99.5%;Cobb角19.6°、4.5°、6.9°。CT检查见:椎管前后径测量伤后、术后、取钉后平均丢失44.9%、16.9%、10.2%。内固定钉、杆断裂发生7例,9枚断钉。结论后路切开复位RF-I型内固定器固定是治疗胸腰椎爆裂性骨折的有效方法。选用双直径角度螺纹钉,加强小关节突间植骨,及时取钉是防止断钉及矫正度丢失的重要措施。Objective To investigate mid- and long-term results of thoracolumbar burst fractures treated with post short-segment RF pedicle instrumentation. Methods One hundred and forty-two patients with single thoracolumbar burst fractures were managed with posterior RF-Ⅰ pedicle instrumentation. Results Among 27 patients who had incomplete spinal cord injury preoperatively, 25 patients recovered after operation. The lumbar pain Denis scoring： P1 in 106 patients, P2 in 36 patients. The lumbar function Christian scoring： 3 points 2 cases, 4 points 6 cases, 5 points 34 cases, 6 points 63 cases, 7 points 37 cases. The self-assessment： very satisfaction 102 cases, satisfaction 40 cases. The anterior height/posterior height of the fractured vertebral body at post-trauma ,post-operation and follow-up were respectively 51.8%, 97.2%, 95.6%;92.0%, 99.2% and 99.5%; and the Cobb＇s angle were 19.6°, 4.5°, 6.9°. The spinal canal anteriorposterior diameter in CT scans was measured. The loss rate was 44.9% post-trauma ,16.9% postoperatively and 10.2% after the instru- mentation removed. Screw and rod broken appeared in 7 patients, there were 9 screws broken. Conclusion Posterior short-segment RF-Ⅰ pedicle instrumentation fixation is effective for the treatment of thoracolumbar burst fracture . The facet joint autografting should be performed double diameter angle screw should be selected and the instrumentation should be removed in time. It is important for the prevention from hardware failures and loss of correction.

关 键 词：胸椎 腰椎 骨折 RF内固定器 治疗结果 

分 类 号：R683.2[医药卫生—骨科学] R681.53[医药卫生—外科学]