伤椎置短钉技术治疗胸腰椎爆裂骨折的疗效分析  

Treatment of a thoracolumbar burst fracture with short- segment pedicular screw fixation through the fractured vertebra

作　　者：常锐[1,2] 王丰爱 王海霞[2] 王德春[1] 

机构地区：[1]青岛大学医学院附属医院脊柱外科,青岛266071 [2]山东省巨野县人民医院骨科,274900

出　　处：《中国矫形外科杂志》2014年第8期683-686,共4页Orthopedic Journal of China

摘　　要：[目的]分析探讨伤椎短钉固定的作用及临床意义。为应用该技术治疗胸腰椎爆裂性骨折提供临床依据。[方法]选取2009年2月-2012年9月后路手术治疗的100例胸腰椎爆裂性骨折的临床资料，随机分为2组，A组男28例，女22例，平均年龄35．6岁（25～63岁）；B组男24例，女26例，平均年龄41岁（22～64岁）。其中A组伤椎置短钉治疗胸腰椎爆裂性骨折，即在后路跨伤椎4枚椎弓根钉内固定的基础上，在伤椎完整椎弓根上附加万向型短椎弓根钉1—2枚。伤椎短钉长度为椎弓根长度约30mm左右，不进入椎体。伤椎置钉钉尾高度与上下椎体螺钉钉尾高度尽量一致。B组跨伤椎椎弓根4枚螺钉内固定。所有患者术后随访9～36个月，平均15．8个月。[结果]A组术后矫正率97．1％±2．2％，术后椎管面积改善率42．1％±1．4％，远期丢失率1．2％±1．1％，内固定失效率0；B组术后矫正率85．6％．±5．7％，术后椎管面积改善率27．4％±2．2％，远期丢失率8．6％±3．4％，内固定失效率8％。A组在各方面优于B组（P〈0．05），差异具有统计学意义。[结论]伤椎置短钉固定能减少复位丢失及内固定松动断裂失效，能纠正脊柱后凸畸形，保持长期有效的内固定，是治疗胸腰椎爆裂性骨折的有效手段。[ Objective] This study aimed to evaluate and compare the therapeutic effects of short - segment pedicular screw fixation through the fractured vertebra and cross segment pediele screw fixation in the treatment of thoracolumbar burst fractures, and to observe the stability and reduction results of the two procedures. [ Method ] One hundred patients with a thoracolumbar burst fracture （ Denis classification） treated using a posterior surgical approach from February 2009 to September 2012 were an- alyzed retrospectively. The causes of the fracture were as follows：high fall injury （48）, heavy crush injury （28）, and traffic ac- cident （ 24 ）. The patients were randomly divided into group A （ n = 50 [ 28 men,22 women ], mean age, 35.6 years, range,25 - 63 years） and group B （n =50 [24 men,26 women] ,mean age,41 years,range,22 -64 years）. [Result]The correction rate, postoperative vertebral canal area,long -term loss rate,and failure rate of internal fixation were 97.1% ± 2.2% ,42.1% ±1. 4% , 1.2% ± 1.1% ,and 0% ,respectively, in group A ,and 85.6% ± 5.7% ,27.4% ± 2.2% ,8.6% ± 3.4% ,and 8% ,respec- tively, in Group B. These findings suggested that the clinical results in Group A were superior and statistically different compared to those in Group B （P 〈 0.05 ）. [ Conclusion ] Short -segment pedicular screw fixation through the fractured vertebra can pre- vent postoperative loss of vertebral height and reduce the failure rate of internal fixation. This method can also correct kyphosis and maintain the correction, which is effective in the treatment of a thoraeolumbar burst fracture.

关 键 词：胸腰椎骨折 伤椎椎弓根 内置短钉 

分 类 号：R687.3[医药卫生—骨科学]