后路短节段固定非融合方式治疗严重胸腰椎爆裂骨折  

Posterior short-segment instrumentation without fusion for severe thoracolumbar burst fractures

作　　者：张晓林[1] 马信龙[1] 陈长宝[1] 徐宝山[1] 吕工一[1] 王雪[1] 姜洪丰[1] 

机构地区：[1]天津医院骨科,天津300211

出　　处：《中华创伤杂志》2013年第6期493-497,共5页Chinese Journal of Trauma

摘　　要：目的探讨后路短节段固定非融合方式治疗严重胸腰椎爆裂骨折的临床疗效，评估其术后影像学和功能恢复情况。方法选择2011年7月-2013年3月收治的38例严重胸腰椎单节段爆裂骨折患者进行回顾性分析。手术方式采用后路短节段椎弓根螺钉撑开复位内固定联合伤椎置钉和硫酸钙骨水泥强化，无须后外侧植骨融合。术前、术后摄X线及CT片，测量局部后凸Cobb角、伤椎前柱高度及椎管占位。评估术前、术后及随访时患者视觉模拟评分（visualana—loguescale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）。结果所有患者获得随访平均14个月（3～20个月）。局部后凸Cobb角术前为（21．24±4．3）°，术后即刻为（3．5±1．8）°，末期随访时为（4．8±2．7）°。术前、术后即刻及末期随访时伤椎前缘相对高度分别为（54．8±14．6）％、（91．7±8．0）％、（87．2±6．0）％。椎管占位术前为（48．0±4．5）％，术后为（23．8±7．8）％，末期随访时为（8．8±4．6）％。末期随访时，6例美国脊髓损伤协会（American Spi—nalInjury Association，ASIA）分级C级患者中，2例改善至D级，4例改善至E级；10例D级患者均改善至E级；22例E级患者无变化。末期随访时ODI为15．5±8．8，VAS为（2．3±0．8）分，较术前均明显改善（P〈0．01）。随访期间无内固定并发症发生。结论后路短节段固定非融合方式能有效恢复脊柱矢状序列和伤椎椎体高度，是治疗胸腰椎爆裂骨折的最有效方法之一。Objective To evaluate the clinical efficacy of treatment of severe thoracolumbar burst fractures by posterior short-segment instrumentation without spinal fusion and assess radiographic imaging and function recovery after surgery. Methods Thirty-eight patients with severe monosegmental thoracolumbar burst fractures treated between July 2011 and March 2013 were analyzed retrospectively. Operation procedures were posterior short-segment pediele screw distraction reduction and fixation combined with screw insertion to the injured vertebrae and calcium sulphate augmentation, in addition, there was no need for posterolateral interbody fusion. X-ray and CT were performed before and after operation to evaluate local kyphotic angle, anterior fractured vertebral body height and canal encroachment. Visual analogue scale （VAS） and Oswestry disability index （ODI） were assessed before and after operation as well as in follow-up. Results All patients were followed up for average 14 months （range, 3-20 months）. Local kyphotic angle was （21.2±4.3）° before operation, （3.5 ± 1.8）° immediately after operation, and （4.8±2.7 ）o in final follow-up. Relative anterior vertebral height was （54.8 ±14.6）% before operation, （91.7 ± 8.0）% after operation, and （87.2 ± 6.0）% in final follow-up. Mean canal encroachment was （48. 0 ±4. 5 ）% preoperatively, （23. 8 ± 7. 8 ）% postoperatively, and （8.8 ±4.6 ）% in final follow-up. In final follow-up, six patients with American Spinal Injury Association （ASIA） grade C on admission showed improvement to grade D （n = 2） and grade E （n=4）; 10 patients with ASIA grade E on admission showed improvement to grade E; 22 patients with grade E had no changes. ODI and VAS scored 15.5 ± 8.8 and 2.3 ± 0.8 in final follow-upwith substantial improvement from those before operation （ P 〈0.01 ）. Complications from internal fixation were not found during follow-up. Conclusion Posterior short-segment fixation without fusion is one of the forem

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 内 非融合 

分 类 号：R687.3[医药卫生—骨科学]