棒折弯角度的个性化设计在治疗胸腰段脊柱骨折中的应用  

The application of individual angular design of stick in curing fractures of thoraco-lumbar vertebrate

作　　者：朱小建[1] 成红兵[2] 曹建华[1] 冒维海 周聪[1] 丁正美 陈义荣[1] 

机构地区：[1]江苏省南通市第四人民医院骨科,南通226005 [2]南通市中医院骨科

出　　处：《南通大学学报（医学版）》2012年第1期25-27,共3页Journal of Nantong University(Medical sciences)

基　　金：南通市科技局指令性课题(S2010047)

摘　　要：目的:探讨棒折弯角度的个性化设计在手术治疗胸腰段脊柱骨折中的应用。方法:根据骨折后标准胸腰段侧位片,骨折椎体所在运动节段的矢状面成角以其上下运动节段矢状面成角均值替代,其替代均值、下运动节段矢状面成角、上椎体矢状面成角三者之和作为所固定节段的矢状面cobb值,以此cobb角值作为术中钛棒折弯角度行后路复位固定胸腰段脊柱骨折50例,随访6个月以上,平均18个月,50例均术前、术后、末次随访时拍摄腰椎正侧位片,其中28例术前、末次随访均行CT检查,17例末次随访行磁共振检查。结果:X线评价:术后椎体的前、后缘高度及cobb角平均复位分别为6.39 mm、2.76 mm、22.56°,随访时矫正的丢失分别为1.06 mm、0.42 mm、1.57°;神经系统:有神经部分损伤的患者按Frankel分级均有1级以上的恢复,完全性脊髓损伤者有部分恢复;腰痛末次随访按Oswestry功能障碍指数问卷表评分:0分17例,2分15例,3分11例,6分2例,8分2例,56分1例,80分1例,87分1例;发生钉棒松动1例,尾丝松动2例,未发生螺钉断裂及棒断裂。均未取出内固定。结论:胸腰段单节段脊柱骨折时,骨折椎体所在运动节段的矢状面成角以其上下运动节段矢状面成角均值替代,其替代均值、下运动节段矢状面成角、上椎体矢状面成角三者之和作为所固定节段的矢状面cobb值,以此cobb角值作为术中钛棒折弯角度行后路复位固定胸腰段脊柱骨折,能够较准确恢复需要固定节段的生理弧度,中长期随访效果肯定。Objective： To analyze the clinical result of the application of individual angular design of stick in curing fractures of thoraco-lumbar vertebrate.Methods： According to the standard preoperative lateral projection of thoraco-lumbar vertebrate,the average value on sagittal plane value of its upper and subtus athletic segment is regarded as the angle on sagittal plane of the fractured athletic segment.The sum of the average angle,the angulation of subtus athletic segment and the angle of subtus vertebral body is regarded as the intraoperative bending angle of stick.Fifty cases of fractures of thoraco-lumbar vertebrate were followed-up for at least six months and average 18 months.All of them were checked with radiography pre-and post-operation.At final follow-up assessment all cases were checked with radiography,also 28 cases were checked with CT.Results： After operation the correction of anterior vertebral body height averaged 6.39 mm,posterior vertebral body height 2.76 mm,cobb angle 22.56°.At final follow-up correction loss averaged 1.06 mm in the anterior,0.46 mm in the posterior,1.57° in the cobb angle.Neurological status improved at least 1 Frankel greade in the patients who had preoperative incomplete paraplegia,while no improvement was obtained in those who had preoperative complete paraplegia.Clinical curative effect was evaluated acording to ODI,the result showed 0 degree 17 cases,2 degree 15 cases,3 degree 11 cases,6 degree 2 cases,8 degree 2 cases,56 degree 1 case,80 degree 1 case,87 degree 1 case.Nuts loosened in 1 case,pedicle screws loosened in 1 case,sticks broken in 0 case.Conclusion： The application of individual angular design of stick can exactly regain physiologic curve of the fixed thoraco-lumbar segment.The effect in long term follow-up is positive.

关 键 词：胸椎 腰椎 脊柱骨折 矢状面 

分 类 号：R681.54[医药卫生—骨科学]