胸腰椎爆裂骨折伴椎间盘损伤形态学分型的临床应用研究  

Research of clinical application of morphological typing of thoracolumbar burst-fracture with intervertebral disc injury

作　　者：周成洪[1] 龙亨国[1] 沈万祥[1] 黄伟[1] 洪文跃[1] 刘玖行[1] 虞杰[1] 

机构地区：[1]浙江省舟山市中医骨伤联合医院,浙江舟山316000

出　　处：《中医正骨》2011年第11期10-13,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：浙江省舟山市医药科技计划资助课题(2010-B-04)

摘　　要：目的:探讨胸腰椎爆裂骨折伴椎间盘损伤患者,根据骨折和椎间盘损伤程度不同分型采用不同植骨融合手术方式的疗效。方法:回顾分析我院80例胸腰椎爆裂骨折伴椎间盘损伤患者,根据胸腰椎爆裂骨折Denis分型和椎间盘损伤Oner分型进行分型分组并采用不同手术方式:A组28例,其中A/Ⅰ型2例、A/Ⅱ型5例、A/Ⅲ型3例、B/Ⅱ型3例、B/Ⅲ型2例、C/Ⅲ型9例、E/Ⅱ型3例、E/Ⅲ型1例,采用单纯后路内固定伤椎椎体内植骨术;B组26例,其中A/Ⅳ型3例、A/Ⅴ型4例、B/Ⅳ型5例、B/Ⅴ型3例、C/Ⅳ型4例、E/Ⅴ型4例,后路内固定伤椎椎体内植骨加后路植骨融合术;C组14例,其中D/Ⅰ型2例、D/Ⅱ型7例、D/Ⅲ型5,采用后路内固定伤椎椎体内植骨加后路植骨融合术;D组12例,其中D/Ⅳ型7例、D/Ⅴ型5例,采用后路内固定伤椎椎体内植骨加椎间植骨融合术术后通过观察伤椎高度,Cobbs角丢失,三维CT平扫评价植骨愈合情况。结果:四组患者术后均获随访,随访时间18～36个月,平均24.4个月,所有患者影像学复查未见内固定松动、断裂,无假关节形成及后凸畸形的发生,椎体的高度和曲度无明显丢失,三维CT显示术后3个月以上植骨界面完全融合。结论:术前对胸腰椎爆裂骨折类型及椎间盘损伤情况的综合评估,制定有效的固定融合手术方法,可有效防止内固定失败,复位丢失和后凸畸形,是治疗胸腰椎爆裂骨折伴椎间盘损伤的有效方法。Objective：To evaluate each operational efficacy after the patients suffered from thoracolumbar burst-fracture with intervertebral disc injury were treated with different surgical approach to graft and fuse bone by typing them according to the degree of fracture and injury of intervertebral disc. Methods：To type and group the 80 patients suffered from thoracolumbar burst-fracture with intervertebral disc injury according to Denis type of thoracolumbar burst-fracture and Oner type of intervertebral disc injury, and to adopt different surgical approach ： Group A,28 cases, including 2 cases A/I,5 cases A/II,3 cases A/III, B/III 2 cases, C/III 9 cases, E/If 3 cases, E/III 1 cases, o be done the operations of fixing the ill intervertebral bodys internally and grafting bone inside it by the pure posterior approach;Group B ,26 ca- ses,including A/IV 3 cases,A/V 4eases, B/IV 5 cases, B/V 3 cases, C/IV 4 cases,E/V 4 cases,to be done the operations of fixing the ill intervertebral bodys internally and grafting and fusing bone by the posterior approach;Group C, 14 cases,including D/I 2 cases, D/II 7 cases, D/III 5 cases, to be done the operations of fixing the ill intervertebral bodys internally and grafting and fusing bone by the posterior approach;Group D, 12 cases,including D/IV 7 cases,D/V 5 cases,to be done the operations of fixing the ill intervertebral bodys and grafting bone inside it, and grafting and fusing bone between the intervertebral body by the posterior approach. To evaluate the condition of bone graft healing by observing the ill vertebral height, lost of Cobbs horns, three-dimensional CT flat esau after operations. Results：All the 4 groups of cases were followed up for 18-36months,average 24.4 months, no internal fixation loosening or fracture, no occurrence of pseudarthrosis and after protrusion deformity, no obvious lost of the height and curvature of vertebral body were seen in their imaging review. Three-dimen- sional CT after 3 months showed bone graft interface merged fully. Conclusion：To e

关 键 词：脊椎骨折 胸椎 腰椎 椎间盘 手术方式 

分 类 号：R687.3[医药卫生—骨科学]