短节段经伤椎椎弓根螺钉治疗胸腰段骨折  

Posterior short-segment pedicle screw fixation at the injured level for thoracolumbar spine fractures

作　　者：朱云荣[1] 叶晓健[1] 余将民[1] 蒋玉权[1] 王会学[1] 范纯泉[1] 何海龙[1] 许国华[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华创伤杂志》2010年第3期221-224,共4页Chinese Journal of Trauma

摘　　要：目的 探讨短节段经伤椎椎弓根螺钉治疗胸腰段骨折的适应证、手术方法及临床疗效.方法 对我科从2005年1月至2008年12月收治的38例压缩性骨折和轻中度爆裂性骨折行短节段椎弓根螺钉内固定组（A组）和短节段经伤椎椎弓根螺钉内固定组（B组）各19例.采用伤椎椎体恢复度（R）值（伤椎前缘高度/临近椎体前缘高度的均值×100%）、伤椎后凸Cobb角、神经功能恢复情况（Frankel评分）、患者疼痛的视觉模拟疼痛评分（VSA）及内固定状况进行比较.结果 所有患者均得到6～37个月（平均20.5个月）随访.两种术式术后Frankel评分无明显差异,但B组VAS评分、R值、Cobb角恢复明显优于A组.A组出现螺帽松动、螺钉折弯各1例,无内固定物断裂、松动、脱出.结论 采用短节段经伤椎椎弓根螺钉是治疗压缩性和轻中度爆裂性胸腰段骨折的一种切实有效的方法.Objective To discuss indications,operation method and clinical outcome of posterior short-segment pedicle fixation at the injured level for treatment of thoracolumbar spine fractures.Methods A total of 38 patients with thoracolumbar spine fractures were equally randomized to Group A（treated with classic short-segment pedicle screw fixation）and Group B（treated with short-segment pedicle screw fixation at the injured level）based on fixation methods（19 patients per group）.Preoperative and postoperative JOA score,segmental lordosis（Cobb＇ s angle）,R value（anterior fractured vertebral body height/mean normal vertebral body height×100%）,VSA score and internal fixation condition were assessed and compared clinically.Results All patients were followed up for 6-37 months（mean 20.5 months）,which showed no statistical difference upon Frankel scores of two operation modes,while the segmental lordosis,VAS score and R value in Group B were than those in Group A.There occurred nuts loosening in one patient and screw bending in one in Group A.There was no implant breakage,loosening or emersion in Group B.Conclusion Posterior short-segmental fixation at the injured level is an adequate and effective procedure for compression fractures and mild to moderate burst fractures of the thoracolumbar spine.

关 键 词：脊柱骨折 胸椎 腰椎 短节段固定术 

分 类 号：R687.3[医药卫生—骨科学]