导针定位在胸腰椎骨折前路手术中置钉的应用研究  

Clinical Evaluation of the Pin Guide Nailing in Surgery via Anterior Approach for Thoracolumbar Fracture

作　　者：马立泰[1] 刘浩[1] 杨毅[1] 龚全[1] 李涛[1] 王贝宇[1] 邓宇骁[1] 丁琛[1] Ma Litai;Liu Hao;Yang Yi;GONG Quan;LI Tao;WANG Beiyu;DENG Yuxiao;DING Chen(Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院骨科,四川成都610041

出　　处：《实用骨科杂志》2018年第4期294-297,共4页Journal of Practical Orthopaedics

基　　金：四川省科技厅支撑项目(2016FZ0038)

摘　　要：目的对比分析术中导针定位在胸腰椎骨折前路手术中置钉的临床应用及价值。方法前瞻性对照分析2014年5月至2016年10月行胸腰段前路手术的60例患者,获得随访的患者53例。53例中男33例,女20例;年龄27~61岁,平均(39.4±12.8)岁。损伤类型:车祸伤6例,重物砸伤10例,高处坠落伤37例。骨折椎体节段:T_(11)椎体0例,T_(12)椎体5例,L_1椎体37例,L_2椎体6例,L_3椎体4例,L_4椎体1例。骨折椎体AO分型:A型50例,B型3例。脊髓损伤Frankel分级:A级6例,B级4例,C级10例,D级21例,E级12例。内固定材料:Antares或Anterior。术前将患者随机分为两组:定位组和非定位组,定位组在术中置钉前应用克氏针在椎体上临时定位确定椎体正位像上螺钉进钉方向,非定位组则根据椎体的形态确定进钉方向。随访时定位组25例,非定位组28例。测量术后椎体螺钉与相应终板的夹角以及术前、术后及末次随访时的冠状面Cobb角、术中出血量、自体血回收量、手术时间、患者的神经功能恢复情况。结果所有患者均采用伤椎上位两个节段的平面入路。定位组术后冠状面Cobb角是(1.89±3.18)°,非定位组为(3.26±3.09)°。定位组中有1例出现超过5°以上的侧方成角,非定位组有7例术后冠状面Cobb角在5°以上,2例超过10°,随访时无明显变化,两组比较差异有统计学意义(P<0.05)。定位组有92枚(92%)螺钉与终板的夹角小于5°;非定位组有70枚(62.5%)螺钉与终板的夹角小于5°,两组比较差异有统计学意义(P<0.01)。定位组术中出血量(230.4±209.8)mL,术中自体血回输量(170.0±132.0)mL;1例于术中术后输异体血300mL,手术时间(158.2±57.4)min;非定位组术中出血量(300.5±252.5)mL,术中自体血回输量(230.0±130.5)mL,5例于术中术后输异体血200~600mL,手术时间(180.1±65.4)min。两组的术中出血量及手术时间差异有统计学意义。结论术中导针定位提高了椎体螺钉平行于终板的准确率,�Objective To comparative study the clinic application of guide pin during operation via anterior approach for thoracolumbar fractures.Methods We prospective controlled analyzed the direction of nail in 60 patients consecutively treated with surgery via anterior approach in thoracic and lumbar fractures between May 2014 and Oct 2016.There were 53 cases who finished the follow-up in the end.These 53 cases included 33 males and 20 females at the age of 27~61 years(mean 39.4±12.8 years).The causes of injury were falling in 37 patients,traffic accidents in 6 patients,impact from heavy material in 10 patients.The fracture site was T 12 in 5 patient,L 1 in 37 patients,L 2 in 6 patients,L 3 in 4 patients,and L 4 in 1 patients.According to AO classification,50 cases were type A,3 case were type B.According to The Frankel assessment of neurological,status grade was A in 6 cases,B in 4 cases,C in 10 cases,D in 21 cases,and E in 12 cases.Anterior fixation was performed with the Antares and the Anterior(Medtronic,Sofamor Danek)in all patients.The patients were divided into 2 groups randomly:orientation group(25 cases)and non-orientation group(28 cases).In orientation group,kirschner wire were used for X-ray to ascertain the direction of the vertebral screw;In non-orientation group,the shape of the vertebral the superior or inferior endplate.Radiograph images were evaluated for coronal Cobb angle and inserting angle between the screws and end-plates.Amount of bleeding,the amount of blood collected by the body,operative time,and conditions of neurological functional recovery also be recorded.Results All patients’incision level were 2 segments above the injured vertebrae.The mean post-operation coronal Cobb angle of orientation group was(1.89±3.18)°and the non-orientation group(3.26±3.09)°.There were statistical difference between two groups.Amount of bleeding was(230.4±209.8)mL,the amount of blood collected by the body was(170.0±132.0)mL,and operative time was(158.2±57.4)minutes in the orientation group.In the non-ori

关 键 词：胸腰椎 骨折 侧方成角 并发症 预防 

分 类 号：R683.2[医药卫生—骨科学]