经伤椎置钉单椎间复位固定治疗创伤性胸腰椎骨折的远期疗效  

Long-term evaluation of monosegmental transpedicular fixation for thoracolumbar fractures

作　　者：魏富鑫[1] 钟锐[1] 崔尚斌[1] 刘少喻[1] 王乐[1] 黄阳亮[1] 梁子建[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州,510700

出　　处：《中华创伤骨科杂志》2014年第9期760-764,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金-广东联合基金重点项目（C1032001）,广东省科技计划项目（2010B031600203）,广东省自然科学基金项目（S2013010015775）

摘　　要：目的 探讨经伤椎置钉单椎间椎弓根螺钉复位固定治疗创伤性胸腰椎骨折的远期疗效.方法 对2002年10月至2008年12月收治且随访满5年的144例胸腰椎骨折患者资料进行回顾性分析,男88例,女56例;年龄16 ～ 64岁,平均41.4岁.骨折根据AO-ASIF分型：A型109例,B型25例,C型10例;神经功能根据Frankel分级：E级37例,D级78例,C级18例,B级11例.均采用经伤椎置钉单椎间复位固定.比较术前、术后1周及末次随访时胸腰痛的视觉模拟评分（VAS）、伤椎压缩率、cobb角、椎间隙高度及伤椎滑移距离. 结果 所有患者术后获60～120个月（平均77.3个月）随访,手术时间平均为75 min,术中出血量平均为115 mL.术后1周和末次随访时VAS评分[（3.9±1.7）分和（2.3±1.1）分]、伤椎压缩率（20.1％±10.2％和22.7％±5.9％）、cobb角（5.1°±3.2°和7.8°±2.5°）、椎间隙高度[（7.6±1.1）mm和（6.8±1.6） mm]及伤椎滑移距离[（1.1±0.8）mm和（1.0±0.6）mn]与术前[（7.6±2.1）分、58.9％±6.8％、17.5°±3.1°、（4.7±2.1）mm、（3.5±1.4）mm）]比较均有明显改善,差异有统计学意义（P＜0.05）,末次随访时各指标与术后1周比较差异均无统计学意义（P＞0.05）.术后神经功能分级较术前明显改善,差异有统计学意义（Z=-3.752,P=0.033）. 结论 经伤椎单椎间椎弓根螺钉复位固定术可用于治疗大部分创伤性胸腰椎骨折,远期临床效果满意,具有创伤小、手术时间短、出血少、脊椎运动功能单位丢失减少等优点.Objective To evaluate the long-term outcomes of monosegmental transpedicular fixation for thoracolumbar fractures.Methods We retrospectively analyzed 144 cases of thoracolumbar fracture who had been treated and followed up for more than 5 years by our department.They were 88 men and 56 women,aged from 16 to 64 years （average,41.4 years）.According to AO-ASIF classification,109 cases were type A,25 type B and 10 type C.By the Frankel classification,37 cases were rated as grade E,78 as grade D,18 as grade C,and 11 as grade B.They were all treated with monosegmental transpedicular fixation.The visual analogue scale （VAS）,vertebral compression rate,cobb angle,intervertebral space,and spondylolisthesis of the fractured vertebra were compared between preoperation,one week postoperation and the last follow-up.Results They were followed up for 60 to 120 months （average,77.3 months）.The mean operation duration and intraoperative blood loss were 75 minutes and 115 mL,respectively.There were significant improvements between preoperation and postoperation regarding VAS （7.6 ± 2.1 versus 3.9 ± 1.7 and 2.3±1.1）,vertebral compression rate （58.9% ±6.8% versus 20.1% ±10.2% and 22.7% ± 5.9%）,cobb angle （17.5° ± 3.1° versus 5.1° ± 3.2° and 7.8° ± 2.5°）,intervertebral space （4.7 ± 2.1 mm versus 7.6 ± 1.1 mm and 6.8 ± 1.6 mm）,and spondylolisthesis （3.5 ± 1.4 mm versus 1.1 ±0.8 mm and 1.0 ±0.6 mm） （P 〈 0.05）.There were no significant differences between one week postoperation and the last follow-up regarding the above indexes （P 〉 0.05）.The postoperative Frankel grades were significantly better than the preoperative one in all cases （Z =-3.752,P =0.033）.Conclusion Monosegmental transpedicular fixation can be used in most of the traumatic thoracolumbar fractures,because its long-term outcomes are fine and it has advantages of minimal invasion,and limited loss of blood and vertebral motion.

关 键 词：胸椎 腰椎 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]