经椎弓根钉内固定治疗合并后方韧带复合体损伤胸腰椎骨折早期疗效观察  

Early curative effect of transpedicular screw fixation in treatment of thoracolumbar fracture combined with posterior ligamentous complex injuries

作　　者：曹贵君[1] 孟纯阳[1] 张卫红[1] 孔祥清[1] 高峰[1] 吴同申[1] 陈国武[1] 

机构地区：[1]济宁医学院附属医院脊柱外科,272000

出　　处：《中华创伤杂志》2015年第4期307-311,共5页Chinese Journal of Trauma

摘　　要：目的探讨后路经椎弓根钉内固定治疗合并后方韧带复合体（PLC）损伤的胸腰椎骨折早期临床疗效。方法回顾性分析2008年7月-2013年3月行手术治疗的合并PLC损伤胸腰椎屈曲分离型骨折患者22例，其中男16例，女6例；年龄23—62岁，平均39岁。所有患者病情稳定后，在静吸复合麻醉下行后路椎弓根螺钉内固定术。根据骨折移位的程度及韧带损伤的类型行后外侧和（或）椎体间自体植骨。观察术前、术后3d、随访末期的椎体高度恢复率、Cobb角矫正率、美国脊髓损伤协会（ASIA）分级。结果所有患者手术顺利，术中未发生手术并发症；患者均获得随访5～51个月（平均26．5个月）。骨折复位满意，分离的后部结构闭合。椎体前缘高度术后较术前平均改善20．6％（P〈0．01）；Cobb角术后较术前平均改善10．60°（P〈0．01）。术前有神经损伤的8例术后均有不同程度恢复；术后感觉评分较术前平均改善20．7％（P〈0．05），运动功能评分较术前改善30．9％（P〈0．01）。CT三维重建示植骨全部骨性愈合；患者无局部疼痛及内固定物断裂。结论后路经椎弓根钉内固定手术治疗合并PLC损伤的胸腰椎屈曲分离型骨折短期疗效满意，钉棒固定可以达到满意复位、骨折失稳脊柱的三柱即刻稳定；充分植骨是获得永久性稳定的保障。Objective To investigate the preliminary clinical result of thoracolumbar fracture combined with posterior ligamentous complex injuries repaired by posterior transpedicular screw fixation. Methods A retrospective review was performed on 22 patients with thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries treated with transpedicular screw fixation from July 2008 to March 2013. There were 16 males and 6 females with mean age of 39 years （ range, 23-62 years）. After medically stable, posterior pedicle screw fixation was performed under intravenous- inhalational anesthesia. According to the degree of fracture displacement and types of ligament injury, posterolateral bone grafting or intervertebral fusion at the level of injury was conducted. Vertebral height restoration, Cobb＇ s angle and American Spinal Injury Association （ASIA） score were reviewed preopera- tively, at postoperative 3 days and at the last follow-up. Results All the patients were operated on smoothly. There were no complications during operation. All the patients were followed up for 5-51 months （mean, 26. 5 months）. Fracture reductions were satisfied with the closure of vertebral poste- rior element. Mean anterior vertebral height and Cobb＇ s angle improved by 20.6% and 10.60°respec- tively after operation （ P 〈0.01 ）. Eight patients with neurological dysfunction showed some recovery after operation with the mean sensory score improved by 20.7% （ P 〈 0.05 ） and mean motor function score improved by 30.9% （P 〈 0.01 ）. All bone grafts were healed, without pain, loosening or breakage in the fixation system. Conclusions Posterior pedicular screw fixation attains good short-term outcome for thoracolumbar flexion-distraction fracture combined with posterior ligamentous complex injuries. The sur- gery provides satisfactory reduction and instant spinal three-column stability for the unstable spine frac- ture. Sufficient bone graft is the guarantee to permanent stability.

关 键 词：脊柱骨折 胸椎 腰椎 后方韧带复合体 

分 类 号：R687.3[医药卫生—骨科学]