胸腰椎椎弓根骨折分型及螺钉固定安全性研究  

The assessment of possibility of vertebral pedical fixation for treatment of thoracolumbar spine fracture and the classification of the pedical fracture

作　　者：吴卫平[1] 孙业青[1] 李少华[1] 蔡郑东[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《同济大学学报（医学版）》2010年第1期89-93,共5页Journal of Tongji University(Medical Science)

摘　　要：目的研究胸腰椎骨折经骨折椎椎弓根螺钉固定的安全性。方法胸腰椎椎体单节段骨折130例,术前对骨折椎椎弓根行CT扫描,观察椎弓根直径、椎弓根完整性、椎弓根骨折部位。根据CT影像将椎弓根骨折分型。术后CT扫描观察螺钉与椎弓根的关系,评价螺钉置钉的准确率。经骨折椎椎弓根置钉作为研究组,经正常椎椎弓根置钉为对照组,2组间进行比较。结果130例共置入椎弓根螺钉774枚。经骨折椎椎弓根置钉254枚,经正常椎椎弓根置钉520枚。727枚螺钉(93.9%)完全位于椎弓根骨皮质内,47枚螺钉(6.1%)出现偏差。经正常椎椎弓根螺钉发生错误占其置钉数的5.38%;经骨折椎椎弓根螺钉发生错误占其置钉数的7.48%。经骨折椎椎弓根置钉发生偏差19枚;10枚螺钉偏外(Ⅲ度),6枚螺钉偏下(Ⅱ度),3枚螺钉直径过大导致椎弓根内壁膨胀内移(Ⅰ度),都未导致临床不良后果。对两组间螺钉错误发生率进行比较分析,差别无统计学意义。结论经骨折椎椎弓根螺钉固定是安全的方法;对椎弓根骨折分型有利于进钉的位置确定和指导进钉路线。Objective To evaluate the safety of vertebral pedical fixation for the treatment of thoracolumbar spine fracture. Methods One hundred and thirty cases of individual vertebra thoracolumbar spine fracture were chosen. The intacfion of pedicle, the position of pedical fracture and the pedical diameter were observed by pedical CT scanning before surgery. Then make the classification of the pedical fracture. Observe the relation of screws and pedicle by CT scan to evaluate the accuracy of screws after surgery. Compare fractural vertebral pedical fixation with normal vertebral pedical fixation. Results Seven hundred and seventy-four screws were used in 130 cases. 254 stews were placed in fractural vertebra pedical, 520 screws in normal vertebral pedicles. CT scan showed that 727 screws （93.9%） were in pedicles totally, 47 screws （6.1%） occurred deviation. There were 5.38% mistakes in normal vertebral pedical fixation and 7.48% in fractural vertebral pedical fixation. 19 screws occurred deviation,10 screws deviated outward, 6 screws deviated downward, 3 screws were wide in diameter, but had no harmful consequence in clinic. Statistical study showed the differences between the two mistaken teams were not significant. Conclusion Fractural vertebral pedical fixation provides an effective and safe method for the treatment of thoracolumbar spine fracture and has no additional risk. Screws were often mistakenly placed outward or downward. The classification of the pedical fracture is helpful to guide operations.

关 键 词：胸椎 腰椎 骨折分类 椎弓根器械 骨折固定术 

分 类 号：R683.2[医药卫生—骨科学]