串联式经皮椎弓根钉外固定系统治疗多节段非相邻型胸腰椎脊柱骨折  

The Treatment of Multiple-level Noncontiguous Spinal Fractures with Tandem Type Percutanous External Transpedicular Fixation

作　　者：王程[1] 宋西正[1] 晏怡果[1] 彭文 胡文凯[1] 李学林[1] 欧阳智华[1] 陈洋 王文军[1] WANG Cheng;SONG Xizheng;YAN Yiguo;PENG Wen;HU Wenkai;LI Xuelin;OUYANG Zhihua;CHEN Yang;WANG Wenjuna(Department of Spinal Surgery,the First Affiliated Hospital of Nanhua University, Hengyang 421001, Hunan China.)

机构地区：[1]南华大学附属第一医院脊柱外科,湖南衡阳421001

出　　处：《中国中医骨伤科杂志》2018年第5期35-38,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：国家自然科学基金(31570946);湖南省卫生计生委科研计划课题项目资助(A2017016);湖南省重点研发计划(2017SK2104);湖南省研究生科研创新项目资助(CX2017B568)

摘　　要：目的:评价应用串联式经皮椎弓根钉外固定系统治疗多节段非相邻型胸腰椎骨折的初步临床疗效。方法:28例多节段非相邻型胸腰椎骨折患者,应用本院自行研制的串联式经皮椎弓根钉外固定系统联合伤椎植骨术。比较该组患者在术前﹑术后1周及末次随访时的VAS评分和伤椎椎体前缘高度丢失率及椎管面积比。结果:28例患者均顺利完成手术,平均手术时间为112.50min,平均失血量为18.39mL,术后平均随访24个月。VAS评分术前6~9分,平均(7.46±1.14)分,术后1周2~4分,平均为(2.71±0.76)分,末次随访0~2分,平均(0.68±0.72)分。术后1周复查X线片示伤椎椎体前缘高度丢失率由术前的平均37.08%±6.14%减少至7.61%±1.82%,末次随访为8.28%±1.95%;伤椎椎管狭窄率由术前的平均29.43%±5.73%减少至17.79%±6.77%,末次随访为9.56%±4.17%.术后随访患者椎管面积持续恢复,椎体高度有所丢失但较术后1周差异无统计学意义(P<0.05)。结论:应用串联式经皮椎弓根钉外固定系统治疗多节段非相邻型胸腰椎骨折初步临床疗效满意,通过严格把握适应症,慎重选择患者,该术式是一种有效可行的微创手术方式,具有一定的临床应用价值。Objective：To investigate the preliminary clinical efficacy of Tandem type percutanous external transpedicular fixation in the treatment of multiple-level noncontiguous spinal fractures.Method：28 cases of multiple-level noncontiguous thoracolumbar spinal fractures were treated with a self-developed tandem type percutanous external transpedicular fixation combined with allograft bone.The VAS score,anterior vertebral height loss rate of injured vertebra and the spinal stenosis rate of the patient before the operation,one week after operation and at final follow-up were recorded and compared.Result：All 28 patients underwent the operation successfully; with the average operation time of 112.50 min,the average blood loss of 18.39 mL,and the average follow-up time of 24 months.The VAS score is 6～9 points before surgery,with an average of（7.46±1.14）points; and 2～4 points in one week after surgery,with an average of（2.71±0.76）points; and 0～2 points at the final follow-up,with an average of（0.68±0.72）points.The X-ray taken one week after the operation shows the anterior vertebral height loss rate of the injured vertebra is recovered from an average of 37.08%±6.14% before operation to 7.61%±1.82%,which of the final follow-up is 8.28%＋1.95%.The spinal stenosis rate of the injured vertebra recovered from 29.43%±5.73% on average before operation to 17.79%±6.77%,which of final follow-up is 9.56%±4.17%.The patients who are followed up for a long time after the operation have much improvement in spinal canal area.After the long-term follow-up,the area of the vertebral canal continued to improve,though the vertebral height was lost,but there was no significant difference compared with that 1 week after surgery.Conclusion：The preliminary clinical efficacy of tandem type percutanous external transpedicular fixation in the treatment of multiple-level noncontiguous thoracolumbar spinal fractures is satisfied.By strict control of indications and careful selection of patients,the operation is an effec

关 键 词：多节段非相邻型 胸腰椎骨折 椎弓根钉 外固定系统 

分 类 号：R683.2[医药卫生—骨科学]