椎弓根螺钉经后路置入修复多节段胸椎骨折:随访验证椎体高度恢复  

Posterior pedicle screw fixation for repair of multi-segmental thoracic fractures: restoration of vertebral height at follow-up

作　　者：王羿萌[1] 皮斌[1] 朱晓宇[1] 钱忠来[1] 杨惠林[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215000

出　　处：《中国组织工程研究》2014年第48期7763-7768,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省自然青年基金~~

摘　　要：背景:多节段胸椎骨折的发病率逐渐上升,如何有效恢复椎体正常形态及损伤的神经功能,是目前研究的主要方向。目的:观察24例经后路椎弓根螺钉置入内固定修复多节段胸椎骨折的临床疗效。方法:选择2009年1月至2013年12月收治的多节段胸椎骨折患者28例,其中24例得到有效随访,男19例,女5例;年龄20-64岁;均有外伤史;受伤至入院时间为1 h-4 d;均急诊行全脊柱正侧位X射线片和CT平扫+冠矢状位重建,患者在入院后4 d内行全脊柱MRI检查;骨折节段2个节段19例,3个节段3例,4个节段1例,6个节段1例;脊髓功能按ASIA分级:A级10例,B级9例,C级2例,D级2例,E级1例;合并脑损伤3例,肋骨骨折4例,血气胸3例,肺挫伤4例,脾破裂2例,四肢骨折4例。结果与结论:24例患者随访9-37个月,无内固定失败、植骨不融合、神经症状加重。末次随访椎体高度无明显丢失,伤椎愈合良好。末次随访脊髓功能按ASIA分级:A级10例,B级5例,C级2例,D级5例,E级2例。手术节段矢状面Cobb角从内固定前平均26.8°,恢复到内固定后平均5.5°,末次随访平均5.9°。提示多节段胸椎骨折需明确关键损伤部位和神经损伤平面,经后路椎弓根螺钉置入内固定修复多节段胸椎骨折可有效恢复椎体高度,神经减压充分,固定牢靠,可取得良好的疗效。BACKGROUND： The incidence of multi-segmental thoracic fractures gradually increased. How to restore normal vertebral morphology and neurological injury is the main direction of the present study. OBJECTIVE： To observe the clinical therapeutic effects of posterior pedicle screw fixation for repair of multi-segmental thoracic fractures in 24 cases. METHODS： A total of 28 patients with multi-segmental thoracic fractures, who were treated from January 2009 to December 2013, were enrolled in this study. Of them, 24 were followed up, including 19 males and 5 females, with an age of 20-64 years old. They all had a history of trauma. The time taking for transporting to the hospital was between 1 hour and 4 days. All the patients had taken CT plain scan and coronal and sagittal reconstruction and whole-spine lateral X-ray examination in emergency. Whole-spine MRI examination was conducted within 4 days after hospitalization. There were 19 cases of 2-levels thoracic fractures, 3 cases of 3-levels thoracic fractures, 1 case of 4-levels thoracic fractures and 1 case of 6-levels thoracic fractures. There were 10 cases of Grade A, 9 cases of Grade B, 2 cases of Grade C, 2 cases of Grade D and 1 case of Grade E according to ASIA system. Three cases combined with brain injury, four cases with rib fractures, three cases with hemopneumothorax, four cases of pulmonary contusion, two cases of rupture of spleen, and four cases of limb fractures. RESULTS AND CONCLUSION： 24 patients were followed up for 9 to 37 months. No implant failure, nonunion, or neurological deterioration were noted during the follow up. No significant loss of vertebral height was found during the final follow-up, and the vertebrae were healed well. There were 10 cases of Grade A, 5 cases of Grade B, 2 cases of Grade C, 5 cases of Grade D and 2 cases of Grade E according to ASIA system at final follow-up. The Cobb angle improved from 26.8° preoperatively to 5.5° postoperatively, and 5.9° at final follow-up. These data suggested that it is very

关 键 词：植入物 脊柱植入物 多节段 胸椎骨折 后路手术 内固定 随访 椎体高度 

分 类 号：R318[医药卫生—生物医学工程]