固定角度侧块与椎弓根钉棒系统治疗无神经损伤胸腰椎骨折  

The fixed-angle lateral masses and pedicle screw and rod system for thoracolumbar fractures without nerve injuries

作　　者：滕勇[1] 季明华[1] 李强[1] 向阳[1] 张文举[1] 戎帅[1] 郭树章[1] 谷长增[1] 

机构地区：[1]兰州军区乌鲁木齐总医院骨三科,830000

出　　处：《中国骨与关节杂志》2013年第11期645-649,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨后路固定角度侧块、椎弓根钉棒系统治疗无神经损伤胸腰椎骨折的治疗效果。方法2008年10月至2012年2月，38例无神经系统症状的机械不稳定胸腰段爆裂骨折且无需减压的患者，采用后路固定角度侧块（-100、-50、00、50、100）、椎弓根钉棒系统经椎弓根复位固定：无后方韧带复合体损伤者给予单纯短节段固定，有后方韧带复合体损伤但伤椎椎弓根完整者给予伤椎椎弓根螺丝钉固定，合并伤椎椎弓根损伤者给予上下两个椎体固定，所有后方韧带复合体损伤者均后外侧植骨融合。所有病例术后1～3天戴支具下地活动。所有病例均行术前、术后x线片及CT、MRI扫描。结果32例获得了完整的随访，随访时间4～40个月，平均28．2个月，无断钉、断棒、内固定失效；平均手术时间92f82．6±19．2）min；术后伤椎高度由术前平均41．6％，恢复到术后平均91．2％；后凸Cobb’s角由术前平均35．3°，恢复到术后平均7．8°；矢状面位移由术前平均（32．7±7．6）％，恢复到术后（8．7±4．9）％（P〈0．05）。结论固定角度侧块、椎弓根钉棒系统是治疗无神经损伤机械不稳定胸腰段爆裂骨折的一种有效方法，该固定系统具有结构简单，操作简便，固定确实，手术时间短，骨折复位理想等近期优点，但远期疗效尚需进一步随访。Objective To investigate the curative results of fixed-angle lateral masses in the posterior approach and the pedicle screw and rod system in the treatment of thoracolumbar fractures without nerve injuries. Methods From October 2008 to February 2012, 38 patients who had thoracolumbar burst fractures without neurological symptoms or decompression and with mechanical instability were included in the study. They were treated by the fixed-angle lateral masses in the posterior approach （ -100, -50, 00, 50 and 100 ） and reduction and fixation of the pedicle screw and rod system. Single short-segment fixation was performed on the patients without posterior ligamentous complex injuries. Pedicle screw fixation at the injured level was performed on the patients with posterior ligamentous complex injuries and complete pedicle at the injured level. The patients with combined pedicle injuries at the injured level underwent fixation of 2 vertebral bodies up and down. Posterolateral fusion was achieved in all patients with posterior ligamentous complex injuries. Wearing a brace, all patients were able to walk at 1-3 days after the operation. The preoperative and postoperative X-ray, CT and MR/data of all patients were reviewed. Results All patients were followed up thoroughly for a mean period of 28.2 months （ range; 4-40 months ）. No breakage of screws or rods or the failure of internal fixation occurred. The mean operation time was 92 （ 82.6± 19.2 ） minutes. The mean height of injured vertebral bodies was 41.6% preoperatively, which was increased to 91.2% postoperatively. The mean Cobb＇s angle was 35.3° preoperatively, which was decreased to 7.8° postoperatively. The mean sagittal plane displacement was （ 32.7±7.6 ） % preoperatively, which was decreased to （ 8.7±4.9 ） % postoperatively （ P〈0.05 ）. Conclusions It is an ideal treatment method of the fixed-angle lateral masses and pedicle screw and rod system for thoracolumbar burst fractures without nerve injuries and with mechanical instability

关 键 词：胸椎 腰椎 脊柱骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]