后路椎弓根螺钉固定联合前路单节段融合重建治疗不稳定DenisB型胸腰椎爆裂骨折  

Posterior pedicle screw fixation combined with anterior single segment fusion reconstruction of unstable Denis type B thoracolumbar burst fractures

作　　者：胡勇[1] 孙肖阳[1] 赖欧杰[1] 袁振山[1] 董伟鑫[1] 张蛟[1] 朱秉科 陈绪国 许建忠 

机构地区：[1]宁波市第六医院脊柱外科,315040

出　　处：《中华创伤杂志》2017年第12期1072-1079,共8页Chinese Journal of Trauma

摘　　要：目的比较后路椎弓根螺钉固定联合前路单节段融合重建与联合前路双节段融合重建治疗不稳定DenisB型胸腰椎爆裂骨折的临床疗效。方法采用回顾性病例对照研究分析2010年6月-2014年6月收治的62例不稳定DenisB型胸腰椎爆裂骨折患者临床资料，其中男51例，女11例；年龄19～55岁，平均35．1岁。单节段爆裂骨折50例，单节段爆裂骨折合并其他节段的压缩骨折12例。爆裂骨折椎节段：T11 8例，T12 20例，L1 24例，L2 6例，L3 4例。根据手术方式将患者分为A、B两组：A组（30例）行后路椎弓根螺钉固定联合前路单节段融合重建；B组（32例）行后路椎弓根螺钉固定联合前路双节段融合重建。比较两组手术时间、术中出血量；末次随访时的疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和神经功能评价（Frankel分级标准），术前、术后及末次随访时的Cobb角变化、伤椎前缘高度。观察内固定松动断裂、钛网倾斜沉降、植骨融合等情况。结果患者均获随访18～24个月，平均20．8个月。A组手术时间、术中出血量分别为（208．2±15．6）min、（598．3±55．3）ml，B组为（260．1±17．4）min、（662．2±58．5）ml（P〈0．05）。术后两组Cobb角恢复值、伤椎高度恢复率及末次随访时Cobb角丢失值、伤椎高度丢失率差异均无统计学意义（P〉0．05）。末次随访时，A组VAS为（2．5±0．8）分，低于B组的（3．2±1．1）分（P〈0．05）；A组ODI为（20．3±5．8）分，低于B组的（28．2±5．1）分（P〈0．05）。与术前比较，Frankel分级标准均有不同程度的恢复（P〈0．05）。A组1例钛网内的骨质与植骨界面未实现骨性融合，未出现明显的钛网沉降、倾斜等情况；B组3例钛网内的骨质与植骨界面未实现骨性融合，8例出现钛网倾斜、沉降等情况（P〈0．05）。结论对于不稳定DenisB型胸腰椎爆裂骨折，�Objective To compare the clinical effects of posterior pedicle screw fixation combined with anterior monosegmental or bisegmental fusion reconstruction in patients with unstable Denis type B thoracolumbar burst fractures. Methods A retrospective case-control analysis was made on 62 cases of Denis type B thoracolumbar burst fractures treated from June 2010 to June 2014. There were 51 males and 11 females, aged 19-55 years （mean, 35. 1 years）. The injury causes included fall from height in 32 cases, traffic accidents in 24, hit by heavy objects in 6. Fifty cases were with monosegmental burst fractures, and 12 with monosegmental burst fractures combined with other vertebral compressive fractures. The burst fracture levels were at T11 in 8 cases, T12 in 20, L1 in 24, L2= in 6, and L3 in 4. According to the different surgical methods, the patients were divided into two groups ： Group A （ n = 30, treated with posterior pedicle screw fixation combined with anterior monosegmental fusion reconstruction） and Group B （ n = 30, treated with posterior pedicle screw fixation combined with anterior bisegmental fusion construction）. The operation time and intraoperative blood loss were compared between the two groups. Visual analogue scale （VAS）, Oswestry disability index （ODI）, and Frankel scale of neurologic function were compared at last follow-up. The changes of anterior height of fracture vertebrae and Cobb angle of the two groups were also compared preoperatively, postoperatively and at last follow-up. Implant looseness and breakage, titanium mesh tilt, and bone fusion were recorded postoperatively. Results All patients were followed up for 18-24 months （mean, 20.8 months）. The operation time and blood loss in Group A was （208.2 ± 15.6） min and （598.3 ± 55.3 ） ml, respectively. The operative time and blood loss in Group B was （260.1 ± 17.4） min and （662.2 ± 58.3 ） ml, respectively. There were significantly statistical differences between two groups in operation time and bloo

关 键 词：脊柱骨折 胸椎 腰椎 骨折内固定术 内 

分 类 号：R687.3[医药卫生—骨科学]