后路椎弓根内固定联合前路减压植骨术分期治疗胸腰椎爆裂性骨折的疗效观察  

Posterior pedicle screw fixation followed by anterior decompression and fusion for the treatment of thoracolumbar burst fractures

作　　者：武斌[1] 梁杰[1] 谭晓毅[1] 乐锦波[1] 

机构地区：[1]三峡大学人民医院(湖北省宜昌市第一人民医院)骨科,湖北省宜昌443000

出　　处：《中国基层医药》2015年第23期3588-3591,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨后路椎弓根钉内固定、前路减压植骨术分期治疗合并多发伤的胸腰椎爆裂性骨折的临床疗效。方法回顾性分析53例行分期后前路手术治疗的单节段胸腰椎爆裂性骨折患者，比较术前及末次随访时伤椎压缩高度比、Cobb角及椎管容积，应用Frankel评分评估神经功能恢复情况，Fugl—Meyer评分评价运动功能的改善。结果共有49例患者获得随访。末次随访时，患者的伤椎压缩高度比、Cobb角及椎管容积均较术前明显改善（t=24．047，P〈0．01；t=21．815，P〈0.01；t=31．699，P〈0．01）。术前，Frankel分级为：A级6例，B级18例，C级15例，D级10例，E级4例；末次随访时，分别为3例、8例、11例、17例和10例，治疗后神经功能评分较前明显改善（Z=2．997，P=0．003）。治疗前，Fugl—Meyer平均分为（74．65±8．42）分，末次随访时为（90．26±9．17）分，术后患者的运动功能评分明显升高（t=8．963，P〈0．01）。结论I期行后路椎弓根钉内固定，Ⅱ期行前路减压植骨术治疗合并多发伤的胸腰椎爆裂性骨折，临床疗效确切，有利于运动和脊髓功能的恢复。Objective To investigate the clinical effect of posterior pedicle screw fixation combined with anterior decompression and fusion for the treatment of thoracolumbar burst fractures. Methods The clinical data of 53 patients underwent posterior pedicle screw fixation and anterior decompression and fusion were retrospectively analyzed. The vertebral height, Cobb angle, vertebral tube volume, the Frankel gradient and Fugl - Meyer score were recorded and compared before and after treatment. Results 49 patients were followed up. At the last time of follow - up ,the vertebral height, Cobb angle, vertebral tube volume all significantly improved （t = 24. 047, P 〈 0. 001 ;t = 21.815, P 〈 0. 001 ; t = 31. 699 ,P 〈0.001 ）. The Franke] gradient before treatment was： A 6 cases, B 18 cases, C 15 cases, D l0 cases ,E 4 eases. After treatment,it came to 3 cases, 8 cases, 11 cases, 17 cases, l0 cases, respectively. There was significant difference before and after treatment （ Z = 2. 997 ,P = 0. 003 ）. There was significant difference iu Fugl - Meyer score before and after treatment [ （74.65±8.42 ） points, （ 90.26±9. 17 ） points, respectively, P 〈 0. 001 ]. Conclusion There is excellent effect on posterior pedicle screw fixation followed by anterior decompression and fusion for the treatment of thoracolumbar burst fractures. It is good for the recovery of motion and spinal function.

关 键 词：脊柱骨折 椎弓根钉内固定 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]