胸腰段骨折长期固定对关节突关节影响的研究  

Clinical observation on the zygapophyseal joint changes after long-term fixation for thoracolumbar fractures

作　　者：宋泽龙[1] 王永凯[2] 陈刚[2] 

机构地区：[1]滨州医学院临床医学院,烟台264003 [2]滨州市人民医院骨外科

出　　处：《滨州医学院学报》2014年第6期422-424,共3页Journal of Binzhou Medical University

摘　　要：目的探讨脊柱胸腰段骨折后长期椎弓根螺钉固定对关节突关节的影响。方法回顾分析胸腰段骨折后经椎旁肌入路椎弓根螺钉长期固定后取除固定装置51名患者资料。其中男性35例,女性16例,年龄21～57岁,平均年龄为（39.42±9.63）岁。筛选标准：受伤当时骨折类型为压缩骨折,没有后柱损伤的爆裂骨折,椎管占位〈1/3,没有神经损伤,Frankle/ASIA[1]分级为E级,椎弓根螺钉固定时关节突关节无退变,胸腰段骨折后经椎旁肌入路行椎弓根螺钉固定术;固定时间大于1年,经椎旁肌入路取除固定装置。通过矢状位动态X线检查测量固定过的椎体伸屈活动度,CT观察固定范围内的关节突关节的变化,术后疼痛视觉模拟评分（VAS评分）。结果矢状位动态X线检查Cobb角,配对t检验,P〉0.05,伸屈位角度没有统计学差异;CT检查,以单个关节突关节为观察对象,关节突关节关节间隙狭窄75.49%,关节间隙连续性中断10.29%,完整骨痂形成1.47%。结论长期固定后关节突关节即使没有达到骨性融合,也可造成关节突关节活动度消失。Objective To explore the effect of longterm fixation on zygapophyseal joint after thoracolumbar fractures .Meth ods The data of 51 patients with thoracolumbar fracture treated surgery with pedicle screw fixation through the approach be tween the paravertebral muscle then removed the fixation recently to analyze the zygapophyseal joint changes after longterm fixation were retrospectively observed .51 patients ,35 cases of male ,16 cases of female ,aged from 21 to 57 years old ,aver aged （39.42 ＆#177; 9.63） years old ,were analyzed .All adopted cases used the following standards ：thoracolumbar compression frac ture or thoracolumbar burst fracture without posterior column damaged ;spinal canal spaceoccupying less than 1/3;no neuro logical damage（ASIA E）;no zygapophyseal joint degeneration before pedicle screw fixation;the thoracolunmbar fixated more than one year ;remove the pedical screw fixation through the paravertebral muscle .The range of motion of the thoracolumbar that had ever been fixated using the sagittal hypertentionhyperflextion XRay radiography was measured .The degeneration changes of the zygapophyseal using CT scans were observed and the patients graded by VAS .Results The paired t test showed that there was no significant difference between sagittal Cobb＇s angle in the hypertension XRay radiography and in the hyper flexion XRay radiography（P〉0.05） .In the CT scanning ,every single zygapophyseal was observed ,75 .49% of them showed facet joint space narrowing ,10 .29% of them showed interruption of the facet joint space ,1 .47% of them surrounded by bony callus .Conclusion Suffered longterm fixation although the zygapophyseal joint are not bony fusion ,the range of motion of zyg apophyseal joint may disappear .

关 键 词：固定 关节突关节 胸腰段 活动度 

分 类 号：R683.2[医药卫生—骨科学]