后路短节段椎弓根钉棒系统联合伤椎交叉置钉治疗腰椎双椎体爆裂性骨折  

Posterior short-segment pedicle fixation with cross-insertion of the fractured vertebra in the treatment of double lumbar burst fractures

作　　者：刘涛 邱水强 徐志刚 顾继生 陈强 罗振东 吴德升[2] LIU Tao;QIU Shui-qiang;XU Zhi-gang;GU Ji-sheng;CHEN Qiang;LUQ Zhen-dong;WU De-sheng(Department of Orthopaedics,Jiangwan Hospital,Shanghai 200434,China;Department of Spine Surgery,East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]上海市虹口区江湾医院骨科,上海200434 [2]同济大学附属上海市东方医院脊柱外科,上海200120

出　　处：《创伤外科杂志》2019年第6期410-413,共4页Journal of Traumatic Surgery

基　　金：上海市虹口区卫生和计划生育委员会课题资助项目(虹卫1802-19);上海市虹口区临床医学优秀青年人才培养计划资助项目(HKYQ2018-13)

摘　　要：目的探讨后路短节段椎弓根钉棒系统联合伤椎交叉置钉治疗腰椎双椎体爆裂性骨折的临床疗效。方法回顾性分析2012年1月-2016年12月上海市虹口区江湾医院骨科因腰椎双椎体爆裂性骨折接受后路短节段椎弓根钉棒系统联合伤椎交叉置钉的非减压融合手术患者39例。男性23例,女性16例;年龄32~55岁,平均42.2岁;随访13~21个月,平均14.6个月。通过术前、术后1周和末次随访时腰椎侧位X线片测量参数:伤椎前缘高度H1和H2,腰椎前凸角(LL);记录手术前后VAS评分和伤残ODI指数,分析比较各时间节点参数变化。结果第一伤椎前缘高度由术前(15.3±1.3)mm增至术后1周(24.7±1.5)mm(P=0.000),末次随访时(24.5±1.9)mm(与术前比较P=0.000;与术后1周比较P=0.330)。第二伤椎前缘高度由术前(15.4±1.0)mm增至术后1周(25.5±1.8)mm(P=0.000),末次随访时(25.4±1.5)mm(与术前比较P=0.000;与术后1周比较P=0.676);腰椎前凸角LL由术前37.1°±2.2°增至术后1周46.1°±2.2°(P=0.000);末次随访时45.6°±2.5°(与术前比较P=0.000;与术后1周比较P=0.172)。VAS评分由术前(6.9±1.1)分降至术后1周(3.5±0.5)分(P=0.000);末次随访时(2.2±0.6)分(与术前比较P=0.000;与术后1周比较P=0.000)。ODI由术后1周(26.1±2.8)%降至末次随访(14.5±1.3)%(P=0.000)。结论伤椎单边交叉置钉的后路短节段椎弓根钉棒系统治疗腰椎双椎体爆裂性骨折,可有效恢复并维持伤椎高度和腰椎曲度,值得临床推广。Objective To explore the clinical outcomes of posterior short-segment pedicle fixation with cross-insertion of the fractured vertebra in the treatment of double lumbar burst fractures.Methods A total of 39 patients with double lumbar vertebral burst fractures were enrolled,who were treated by posterior short-segment pedicle fixation with cross-insertion of the fractured vertebras without decompression and fusion from Jan.2012 to Dec.2016 in Orthopedics Department of Jiangwan Hospital,Hongkou district,Shanghai.There were 23 males and 16 females,aged 32 to 55(average,42.2) years.They received follow-up of 13 to 21 months,with an average of 14.6 months.Before operation,one week and 12 months after operation,the lumbar spine X-ray was taken to get the imaging parameters including anterior vertebral height(H)and lumbar lordosis(LL).Visual Analog Scale scores(VAS) and Oswestry Disability Index(ODI) were recorded,and parameters were statistically calculated at each time point.Results Anterior vertebral height of the first fractured vertebra(H1) increased from(15.3±1.3)mm to(4.7±1.5)mm(P=0.000)one week post-operation,and at the last follow-up H1 was(24.5±1.9)mm(compared with pre-operation P=0.000;compared with 1 week post-operation P=0.330).Anterior vertebral height of the second fractured vertebra(H2) increased from(15.4±1.0)mm to(25.5±1.8)mm(P=0.000)one week post-operation,and at the last follow-up H2 was(25.4±1.5)mm(compared with pre-operation P=0.000;compared with 1 week post-operation P=0.172).Lumbar lordosis(LL) increased from(37.1±2.2)°to(46.1±2.2)°(P=0.000)one week post-operation,and at the last follow-up LL was(45.6±2.5)°(compared with pre-operation P=0.000;compared with 1 week post-operation P=0.330).VAS decreased from 6.9±1.1 to 3.5±0.5(P=0.000)one week post-operation,and at the last follow-up VAS was 2.2±0.6(compared with pre-operation P=0.000;compared with 1 week post-operation P=0.000).ODI decreased from(26.1±2.8)% one week post-operation to(14.5±1.3)% at the last follow-up(P=0.000).Conclus

关 键 词：腰椎爆裂骨折 双椎体 钉棒系统 伤椎交叉置钉 非融合手术 

分 类 号：R681.5[医药卫生—骨科学]