胸腰椎骨折长节段内固定术后脊柱旋转力线的临床观察  

Rotational alignment imbalance of the spine after long-segment fixation for thoracolumbar fracture

作　　者：王翔[1] 郑明辉[1] 童凯[2] 蔡毅[1] 朱永健[1] 陈建庭[1] 瞿东滨[1] 

机构地区：[1]南方医科大学南方医院脊柱骨科,广东广州510515 [2]南方医科大学南方医院创伤骨科,广东广州510515

出　　处：《中国矫形外科杂志》2017年第20期1835-1840,共6页Orthopedic Journal of China

摘　　要：[目的]观察胸腰椎骨折经后路长节段固定术后脊柱旋转力线的恢复情况,并探讨力线失衡的原因及其临床意义。[方法]分析本院2006年1月~2015年1月收治的45例胸腰椎骨折患者,AOSpine骨折分型为A3、A4、B型,其中男27例,女18例,年龄18~62岁,平均(33.02±10.41)岁,均接受后路长节段椎弓根螺钉内固定术。在正侧位X线片上测量患者手术前后棘突旋转距离(SPRD)及伤椎侧(后)凸Cobb角,统计固定节段长度、螺钉使用总数,计算单个椎体螺钉使用个数。根据术后脊柱旋转力线恢复情况,将患者分为力线良好组和力线失衡组。通过比较两组手术前后的测量指标,探讨力线失衡的原因及其临床意义。[结果]45例患者中,旋转力线良好者占32例(71.11%),旋转力线失衡者占13例(28.89%)。两组术前SPRD比较差异无统计学意义(P>0.05);术后1周及末次随访时,失衡组患者SPRD明显大于良好组(P<0.05)。两组固定节段长度和螺钉使用总数比较差异无统计学意义(P>0.05);而单个椎体螺钉个数,失衡组(1.37±0.32)个,明显少于良好组的(1.71±0.29)个(P<0.01)。[结论]后路胸腰椎长节段内固定能有效复位骨折椎体,恢复脊柱的生物力学特性;但部分患者术后存在脊柱旋转力线失衡的情况,与螺钉固定情况、手术技巧等方面密切相关,对术后脊柱稳定性有重要意义。[Objective] To observe the rotational alignment imbalance of the spine after the treatment of thoracolumbar fracture with posterior long-segment pedicle screws instrumentation, and to explore its causes and clinical significance. [Methods] From January 2006 to January 2015, 45 patients with AO Spine type A3, A4 or B thoracolumbar injuries were treated with posterior long-segment fixation, including 27 males and 18 females with a mean age of 33.02＋10.41 years （range, 18- 62 years）. According to the situation of postoperative rotational alignment of the spine, the 45 patients were divided into bal- anced alignment group （n=32 cases, 71.1%） and imbalanced alignment group （n= 13 cases, 28.9%）. Before and after surgery, the spinous process rotation distance （SPRD）, kyphotic angle and Cobb angle were measured on X-ray films. The number of fixed segments, the total number of used screws, and the number of screws at single vertebra were also calculated respectively. All resuhs were compared between 2 groups in order to find out the reason for postoperative spinal rotation imbalance. [Results] No significant difference was found on SPRD between 2 groups before surgery （P〉O.05）, however, the SPRD in the imbalance group was significantly higher than that in the balance group at 1 week postoperatively and at the final follow-up （P〈0.05）. Moreover, although the number of instrumented segments and the total number of pedicle screws showed no significant differences between the two groups （P〉0.05）, the number of screws used in a single vertebrae in the imbalance group was significantly lower than that of the balance group （1.37±0.32 versus 1.71±0.29, P 〈 0.01） . [Conclusions] Imbalance of the spinal rotation sometimes might occur in the patients with thoracolumbar fracture after posterior long-segment fixation. This phenomenon is closely related to the screw fixation methods and surgical techniques.

关 键 词：胸腰椎骨折 长节段固定 旋转力线 螺钉数目 脊柱稳定 

分 类 号：R687.3[医药卫生—骨科学]