胸腰段爆裂性骨折后路椎弓根钉复位固定矫正丢失原因的临床观察  

Clinical Study on Thoracolumbar Burst Fracture of the Posterior Pedicle Screws Fixation and Reasons of Correction Loss

作　　者：沈文东[1,2] 王快[1,2] 陆军[1,2] 汤月平[1,2] 袁景[1,2] 

机构地区：[1]南京医科大学附属苏州医院 [2]苏州市立医院东区骨科,江苏苏州215001

出　　处：《创伤与急危重病医学》2014年第6期329-332,336,共5页Trauma and Critical Care Medicine

摘　　要：目的探讨胸腰段爆裂性骨折后路椎弓根钉内同定术后伤椎高度恢复和矫正丢失的原因。方法对122例胸腰段爆裂性骨折采用后路跨伤椎短节段椎弓根内固定系统复位固定。根据治疗情况分为3组:A组38例,单纯跨伤椎短节段锥弓根钉复位固定;B组41例,加传统伤椎经椎弓根充填植骨;C组43例,加经伤椎椎弓根撬拨复位塌陷终板椎体充填植骨。监测比较伤椎及椎间隙高度恢复及后期矫正丢失情况。结果术后3组伤椎前缘及后缘的高度恢复、伤椎的椎楔角恢复及伤椎终板塌陷侧椎间隙高度恢复均良好,组间差异无统计学意义(P>0.05)。但随着时间的延长,A组伤椎前缘高度、伤椎的椎楔角丢失明显,与B组、C组比较,差异有统计学意义(P<0.05);A组、B组终板塌陷侧椎间隙高度丢失明显,术后一年取内固定前终板塌陷侧椎间隙高度丢失率组间差异有统计学意义(P<0.05),且至术后18个月(取内固定后半年)其高度丢失率进一步加大。结论胸腰段爆裂性骨折后路跨伤椎短节段锥弓根钉复位固定,能有效恢复伤椎及椎间隙高度,伤椎充填植骨重建前、中柱能有效防止伤椎高度的丢失;后期矫正的丢失主要是终板塌陷侧椎间隙高度的丢失,与塌陷终板的复位密切相关。经伤椎椎弓根撬拨复位塌陷终板后伤椎充填植骨能有效维持伤椎上下椎间盘的解剖空间及生理功能,有效防止矫正度数的丢失,临床效果满意。Objective To investigate the thoracolumbar burst fracture of posterior pedicle screw internal fixation and postoperative recovery of injured vertebral height and reason analysis of correction loss. Methods Include 122 cases of thoracolumbar burst fracture by posterior pedicle internal fixation. All patients were divided into 3 groups according to the therapy. Group A （38 cases） only use short segment pedicle screw fixation;group B （41 cases） plus traditional vertebral pedicle filling with bone graft;group C （43 cases） plus vertebral pedicle poking reduction collapse endplate filling with vertebral body bone graft. The vertebral and intervertebral height and the duration of correction loss recovery were evaluated. Results After the operation, the anterior vertebral and posterior height of vertebral injury recovery, vertebral wedge angle restoration and vertebral endplate of intervertebral space height recovery side of the three groups were good, with no significant difference （ P 〉 0.05 ）. But as the time passing by, the anterior vertebral height, vertebral vertebral wedge angle of group A loss obviously, there was statistically significant difference compared to that of the other two groups （P 〈 0.05 ） ; group A and B endplate side of intervertebral height loss obviously, after a year of taking out internal fixation of endplate side, the loss rate of intervertebral height difference between the groups was statistically significant （P 〈 0.05 ） , and to 18 months after operation （ half the fixation） the height loss rate increase more. Conclusion The posterior inter vertebral short segment pedicle screw fixation of the thoracolumbar burst fracture can effectively restore the injured vertebra and intervertebral height. Filling bone graft to reconstruction of the anterior vertebral column, can effectively prevent the vertebral height loss ;later correction loss is mainly due to the lost of the height of intervertebral space, which is closely related to the collapse of endplate reset.

关 键 词：胸腰椎骨折 锥弓根钉 矫正丢失 

分 类 号：R683.2[医药卫生—骨科学]