不植骨融合经伤椎短节段椎弓根钉内固定治疗胸腰椎骨折  

Short-segment posterior pedicle instrumentation fixation with fractured vertebra without fusion for thoracolumbar fractures

作　　者：曾金才[1] 朱立帆[1] 朱晓东[1] 鞠文[1] 钱学锋[1] 

机构地区：[1]苏州市吴江区第一人民医院(南通大学附属吴江医院)骨科,江苏215200

出　　处：《中国骨与关节损伤杂志》2016年第7期697-700,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨不植骨融合经伤椎短节段椎弓根钉内固定治疗胸腰椎骨折的临床疗效。方法回顾性分析本院自2013-01—2014-12采用不植骨融合经伤椎短节段椎弓根钉内固定治疗的34例胸腰椎爆裂骨折。测量患者术前、术后、取内固定前及末次随访时的伤椎前缘高度(AVH)、伤椎楔形角(AWA)及区域后凸角(LKA),末次随访时采用汉化Oswestry功能障碍指数(ODI)进行腰背痛评分。结果内固定取出时间为术后平均11.9个月,总随访时间平均13.5个月。术后AVH、AWA及LKA较术前明显改善,差异均有统计学意义(P<0.05);但末次随访时AVH、AWA及LKA较取内固定前出现丢失,差异均有统计学意义(P<0.05)。仅1例取钉术中发现一侧连接棒断裂,其余患者至末次随访时未见断钉、断棒现象。末次随访时根据汉化ODI评分:优19例,良12例,可3例,优良率91.2%。在校正末次随访时的AWA因素后,Spearman分析显示末次随访时LKA与汉化ODI评分无明显相关性(r=0.02,P=0.89)。结论在正确选择手术适应证的前提下,采用不植骨融合经伤椎短节段椎弓根钉内固定治疗胸腰椎骨折能取得满意的复位固定效果及临床疗效。作为一种临时内固定方法,建议常规取出内固定物。Objective To assess the clinical effects of short-segment posterior pedicle instrumentation fixation with fractured vertebra without fusion for thoracolumbar fractures. Methods From Jan. 2013 to Dec. 2014, 34 single thoracolumbar fractures treated with this method were studied retrospectively. By measuring patients＇ radiographic parameters such as the anterior of injured vertebra height（AVH）, the wedge angle of injured vertebra（AWA） and the local kyphosis angle（LKA）preoperatively, postoperatively, before removal of the implants and at the final follow-up. For clinical evaluation, the Chinese Oswestry disability index（ODI） was used. Results All patients were followed up for 13.5 months and the average time of implant removal was 11.9 months postoperatively. In comparison with preoperative conditions, the AVH, AWA and LKA postoperatively were all significantly increased（P〈0.05）; however, compared to pre-removal of the implants, those radiographic parameters showed a mild loss of correction at the final follow-up and the differences were statistically significant（ P〈0.05）.Only one connecting rod breakage was found during the operation of implant removal, and no patients reported any implant failures. At the final follow-up, the Chinese ODI scores showed a great satisfaction approximately up to 91.2%; by adjusting the factor of AWA, the Spearman analysis displayed that there was no relativity between the LKA and Chinese ODI（r =0.02,P =0.89）. Conclusion If the appropriate patients can be selected, short-segment posterior pedicle instrumentation fixation with fractured vertebra without fusion for thoracolumbar fractures can be an effective and safe operative technique. As a temporary internal fixation, routinely implant removal is often advised one year after operation.

关 键 词：胸腰椎骨折 内固定 伤椎置钉 不植骨融合 

分 类 号：R687.3[医药卫生—骨科学]