经椎弓根弹性环钻的研制及临床应用  

Development and clinical application of elastic trephine through pedicle of fractured vertebra

作　　者：郭开今[1] 李宏伟[1] 张新珠[1] 袁峰[1] 

机构地区：[1]徐州医学院附属医院骨科,江苏221002

出　　处：《中华医学杂志》2010年第29期2082-2085,共4页National Medical Journal of China

摘　　要：目的 探讨经弹性环钻行伤椎内植骨的可行性及操作方法.方法 回顾性分析2003年3月至2009年7月采用椎弓根内固定加经弹性环钻伤椎内植骨治疗的42例胸腰椎骨折患者的术前、术后及随访期间的胸腰椎X线片,测量伤椎高度与正常高度的比值、脊柱后凸Cobb角及矢状位指数.结果 术后随访12～26个月,平均14.8个月,骨折均达到满意复位并愈合,伤椎高度、Cobb角、矢状位指数均得到明显恢复,未发生内固定断裂和螺钉松动现象,也无明显矫正度丢失现象.结论 经弹性环钻行伤椎内植骨重建了椎体高度,增加了脊柱前柱的抗压稳定性,可有效地防止内固定失败和矫正度丢失.弹性环钻使用方便,兼有辅助复位、植骨重建的双重作用.Objective To evaluate the feasibility and surgical procedure of bone grafting with elastic trephine. Methods A total of 42 cases of thoracolumbar fracture received pedicle screw fixations by combining bone grafting with elastic trephine through pedicle of fractured vertebra. The ratios of the altitude of traumatic vertebra to normal altitude, kyphosis Cobb angle and sagittal index were measured by preoperative and postoperative X-ray images. Results A follow-up visit of 12-26 months （average： 14. 8）showed that the dislocations of vertebrae were corrected and fusions completed. Proportion of the height of anterior edge of traumatic vertebra to normal height was （ 53.89 ± 6. 57 ） % at pre-operation, （ 92. 31 ±11.25） % at post-operation and （ 91.39 ± 10. 28 ） % at an one-year follow-up （ P 〈 0. 05 ）. The kyphosis was （23. 19 ±5.74） ° Cobb angle at pre-operation, （4. 92 ± 1.03 ） ° at post-operation and （5.13 ± 1.41 ） °at an one-year follow-up （ P 〈 0. 05 ）. In contrast with 86% （78 % -97% ） on average at post-operation, the pre-operative sagittal index was 54% （32% -66% ） on average. Conclusion Application of bone grafting with elastic trephine can reconstruct the altitude of injured vertebral body, increase the compressive stability of anterior column as well as effectively correct the kyphosis deformity. With a convenient application,elastic trephine plays a variety of roles in both auxiliary reduction and bone grafting reconstruction.

关 键 词：脊柱骨折 内固定器 骨移植 

分 类 号：R687.3[医药卫生—骨科学]