腰椎爆裂骨折侧前方入路改良内固定方式重建腰椎前凸  

Modified Internal Fixation through Anterolateral Approach for Thoracolumbar Burst Fracture to Reestablish the Lumbar Cure

作　　者：张赫[1] 李正维[1] 冯大鹏[1] 赵智[1] 李光灿[1] 南丰[1] 袁亮[1] 

机构地区：[1]大连医科大学附属第二医院脊柱外科,辽宁大连116023

出　　处：《实用骨科杂志》2015年第7期577-581,共5页Journal of Practical Orthopaedics

摘　　要：目的研究侧前方改良内固定手术对腰椎爆裂骨折腰椎前凸恢复的可行性。方法本文为回顾性研究,自2000年5月至2014年10月,统计了103例有完整资料的行手术治疗的腰椎爆裂骨折患者,其中20例患者接受传统侧前方手术,58例患者接受传统后路手术,25例患者接受侧前方改良内固定手术。测量手术前后腰椎前凸角,并作为评价标准进行统计学分析。结果传统侧前方入路手术术前及术后的L2前凸角度为(-14.75±1.67)°和(5.63±0.91)°,L3为(-11.86±2.41)°和(6.71±1.50)°,L4为(-15.20±1.92)°和(11.60±1.14)°;随访1年后L2的前凸角度为(4.83±0.83)°,L3为(5.86±1.35)°,L4为(10.60±1.14)°。而侧前方入路改良内固定手术术前及术后L2前凸角度为(-13.36±2.29)°和(8.90±1.30)°,L3为(-13.11±2.57)°和(15.67±1.58)°,L4为(-13.40±2.40)°和(22.60±2.07)°。随访1年后L2的前凸角度为(7.81±1.08)°,L3为(14.67±1.41)°,L4为(21.2±2.05)°。传统后路手术L2术前及术后的前凸角度为(-8.53±2.08)°和(9.93±2.27)°,L3为(-9.39±1.88)°和(16.33±1.24)°,L4为(-10.90±2.02)°和(23.70±2.00)°。随访1年后L2的前凸角度为(9.03±1.99)°,L3为(15.50±1.25)°,L4为(23.10±1.60)°。传统侧前方手术与传统后路手术术后L2、L3、L4的前凸角度比较P值均小于0.05,传统侧前方手术与侧前方改良内固定术后L2、L3、L4的前凸角度比较P值也均小于0.05。侧前方改良内固定及传统后路手术术后L2前凸角度比较P值为0.181,L3P值为0.131 6,L4P值为0.351 4。改良6钉术式术后与随访1年的结果比较L2P值为0.054 3,L3为0.178 0,L4为0.243 3。结论侧前方入路改良内固定手术对腰椎爆裂骨折腰椎前凸的重建较传统侧前方入路手术更为满意。Objective To study the methods of modified operation technique through anterolateral approach for thoracolumbar burst fracture. Methods There were 103 thoracolumbar burst fractures patients with the complete information. There were 20 patients received traditional anterolateral approach operation,and 25 patients received improved fixation through anterolateral approach,58 patients received posterior approach operation. The follow-up duration after dischange from the hospital was 1 year. Results The mean preoperative and postoperative lumbar lordosis angle in the traditional anterolateral approach group were（-14. 75 ± 1. 67） and（ 5. 63 ± 0. 91） in L2,were（-11. 86 ± 2. 41） and（ 6. 71 ± 1. 50） in L3,were（-15. 20 ±1. 92） and（ 11. 60 ± 1. 14） in L4. Improved fixation through anterolateral approach group were（-13. 36 ± 2. 29） and（ 8. 90 ±1. 30） in L2,were（-13. 11 ± 2. 57） and（ 15. 67 ± 1. 58） in L3,were（-13. 40 ± 2. 40） and（ 22. 60 ± 2. 07） in L4. Posterior group measured were（-8. 53 ± 2. 08） and（ 9. 93 ± 2. 27） in L2,were（-9. 39 ± 1. 88） and（ 16. 33 ± 1. 24） in L3,were（-10. 90 ± 2. 02） and（ 23. 70 ± 2. 00） in L4. Postoperatively,the lumbar lordosis angle of traditional 4 screw group and improved 6 screw anterolateral group were significant different（ P〈0. 05）,and raditional 4 screw group and posterior group were different（ P〈0. 05）,improved 6 screw anterolateral group and posterior group L2 were not significarely different,P = 0. 181;and L3： P = 0. 131 6; L4： P = 0. 351 4. At the 1 year follow-up examination,postoperative L2 lordosis angle in improved 6 screw anterolateral group had been compared,P = 0. 054 3; and L3： 0. 178 0,L4： 0. 243 3. Conclusion Evaluation of the authors＇ s results shows that angular deformity is more successfully corrected and maintained when the modified fixation through anterolateral approach is used.

关 键 词：侧前方入路 腰椎爆裂骨折 腰椎前凸 矢状位失衡 内固定 

分 类 号：R683.2[医药卫生—骨科学]