胸腰椎爆裂性骨折正常矢状曲度的个体化测量及临床应用  

Individual measurement of normal sagittal curvature and its clinical application for thoracolumbar burst fractures

作　　者：吴超[1] 谭伦[1] 林旭[1] 张焰[1] 胡海刚[1] 

机构地区：[1]四川省自贡市第四人民医院骨科,643000

出　　处：《中华创伤骨科杂志》2013年第9期768-772,共5页Chinese Journal of Orthopaedic Trauma

基　　金：四川省卫生厅科学研究项目（080424）

摘　　要：【摘要】目的探讨获得胸腰椎爆裂性骨折正常矢状曲度的方法及其临床应用疗效。方法对2010年6月至2012年1月收治的69例胸腰椎爆裂性骨折患者的临床资料进行回顾性研究，男41例，女28例；年龄18～71岁，平均39．3岁。骨折节段：T11 6例，T12 22例，L1 20例，L212例，L36例，L3例；术前神经功能按美国脊髓损伤协会分级（ASIA）：A级2例，B级4例，C级8例，D级20例，E级35例。术前模拟手术恢复胸腰椎正常矢状曲度并测量其数值，术中通过椎弓根螺钉与上终板平行，按术前测量数值个体化预弯连接棒角度个体化恢复胸腰椎正常矢状曲度。记录并比较患者术前、术后即刻、末次随访时的伤椎前缘高度比值、同定节段矢状曲度丧失角度及椎管占位程度。结果本组患者手术时间100～200min，平均137min；所有患者术后获12～25个月（平均14．3个月）随访。术后即刻和末次随访时的椎体前缘高度比值、固定节段矢状曲度丧失角度及椎管占位程度与术前比较差异均有统计学意义（P〈0．05），而末次随访时与术后即刻比较差异均无统计学意义（P〉0．05）。均未见内固定松动、断裂发生，脊髓神经功能障碍术后无加重，67例不全截瘫患者ASIA分级均有1级以E改善。结论通过术前模拟手术个体化测量正常矢状曲度，按术前测量数值个体化预弯连接棒角度可以更好地恢复胸腰椎爆裂性骨折的椎体高度及矢状曲度，正常矢状曲度的恢复可以明显减少术后固定节段矢状角度的丢失和内固定断裂、松动的发生。Objective To explore the methods of measuring the normal sagittal curvature individu- ally and its clinical application in the treatment of thoracolumbar burst fractures. Methods From June 2010 through January 2012, 69 patient with thoracolmnbar burst fracture were treated in our department. They were 41 men and ？8 women, aged from 18 to 71 years （mean, 39.3 years）. Fracture levels： Tll in 6, T12 in 22, LI in 20, T12 in 12, T3 in 6, and IA in 3 cases. The preoperative neural function by the American Spinal Injtu Association （ASIA） system： grade A in 2, grade B in 4, grade C in 8, grade D in 20 and grade E in 35 cases. In the individualized surgical simulation before operation, the restored normal sagittal curvature of the patient was measured and the values were used for pre-bending of the connection rod. The compression ratio of anterior border heights of the injured vertebra, angle of sagittal curvature loss of the fixated segment and spinal canal compromise were recorded and compared preoperation, immediate post-operation and at the last follow-up. Results The operation time ranged from 100 to 200 minutes in this series （average, 137 minutes） . All the patients were followed up for 12 to 25 months （average, 14. 3 months） . There were sig- nificant differences between preoperation and postoperation regarding the compression ratio of anterior border heights of the injured vertebra, angle of sagittal curvature loss of the fixated segment and spinal canal compromise （ P 〈 0.05）, but no significant differences between immediate postoperation and last follow-up （ P 〉 0.05） . There was no breakage of the pedicle screw or loosening of the implant. The neural malfunction did not dete- riorate post-operation. All the 67 patients with incomplete paraplegia had more than one grade improvement in ASIA grading. Conclusions Individual measurement of normal sagittal curvature in a surgical simulation before operation can yield valuable values for prebending of the connection rod to facilitate

关 键 词：脊柱损伤 骨折 成像 三维 矢状曲度 模拟手术 

分 类 号：R687.3[医药卫生—骨科学]