椎弓根钉联合锁定板短节段固定治疗颈7/胸1骨折脱位的临床疗效  

Pedicle screw combined with locking plate short segment fixation for treating cervical 7/thoracic 1 fracture dislocation

作　　者：卢公标[1] 靳留忠 陆继收[1] 邢宝华[1] 权正学[2] LU Gongbiao;JIN Liuzhong;LU Jishou;XING Baohua;QUAN Zhengxue(Department of Spine Surgery,Jining No.1 People′s Hospital,Jining,Shandong 272011,China;Department of Orthopedics,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]山东省济宁市第一人民医院脊柱外科,272011 [2]重庆医科大学附属第一医院骨科,400016

出　　处：《重庆医学》2019年第21期3669-3672,共4页Chongqing medicine

摘　　要：目的探讨椎弓根钉联合锁定板短节段固定治疗颈7/胸1骨折脱位的临床疗效。方法济宁市第一人民医院2007年7月至2018年7月共收治颈7/胸1骨折脱位患者45例,选择其中13例给予后路复位椎弓根钉、前路取髂骨植骨锁定板短节段联合内固定。统计手术时间、出血量,观察并发症。CT扫描观察椎弓根螺钉置入准确性及椎间植骨融合情况,JOA评分评价手术前后脊髓功能变化,VAS评分评估术后疼痛缓解程度。结果患者手术时间150~260 min,平均(194.62±29.90)min,出血量120~300 mL,平均(188.85±67.89)mL。术后出现颈后部切口脂肪液化及颈前部血肿各1例。共置入颈7、胸1椎弓根钉各26枚,术后1周CT显示,3枚颈7椎弓根钉部分螺纹穿破椎弓根外侧壁。末次随访CT显示内固定物位置无改变,椎间植骨均骨性融合。术前VAS评分(7.08±1.26)分,与术后1周(2.62±0.51)分、术后3个月(2.23±0.60)分、末次随访(1.85±0.56)分比较,差异有统计学意义(P<0.05)。术前JOA评分(8.46±3.80)分,术后1周(8.69±3.82)分,改善率(0.03±0.05)×100%;术后3个月(8.85±3.83)分,改善率(0.05±0.06)×100%;末次随访(9.31±3.68)分,改善率(0.10±0.08)×100%。结论椎弓根钉联合锁定板短节段固定治疗颈7/胸1骨折脱位,安全、复位满意、内固定可靠,对颈椎活动度影响小,治疗效果确切。Objective To explore the clinical efficiency of pedicle screw combined with locking plate short segment fixation in with cervical 7/thoracic 1 fracture and dislocation.Methods A total of 45 patients with neck 7/thoracic 1 fracture and dislocation were admitted in the First People's Hospital of Jining City from July 2007 to July 2018.Among them,13 cases of patients were treated with pedicle screw combined with locking plate short segment jointing with internal fixation.The operation time and blood loss volume were counted,and complications were observed.CT scan was used to observe the accuracy of pedicle screw placement and intervertebral bone graft fusion.The JOA score was used to evaluate the changes of spinal cord function before and after surgery.The VAS score was used to evaluate the degree of postoperative pain relief.Results The operative time was 150-260 min,averaged(194.62±29.90)min,and the blood loss volume was 120-300 mL,averaged(188.85±67.89)mL.Postoperative fat liquefaction in the posterior cervical incision and anterior neck hematoma occurred in 1 case each.A total of 26 cervical pedicle screws and 26 thoracic pedicle screws were placed.The CT scan in postoperative 1 week showed that 3 cervical pedicle screws at cervical 7 partially perforated through the lateral wall of the pedicle.CT of the last follow-up showed that no change in the position of the internal fixator,and all the intervertebral bone grafts were bone fusion.The VAS score was(7.08±1.26)points before surgery,(2.62±0.51)points at postoperative 1 week,(2.23±0.60)points in postoperative 3 months and(1.85±0.56)points at the last follow-up.There were significant differences between each time point and preoperation(P<0.05).The JOA score was(8.46±3.80)points before surgery and(8.69±3.82)points in postoperative 1 week,with improvement(0.03±0.05)×100%.The JOA score was(8.85±3.83)in postoperative 3 months with improvement(0.05±0.06)×100%.The last follow-up JOA score was(9.31±3.68)points with improvement(0.10±0.08)×100%.Conclusion

关 键 词：颈椎 胸椎 骨折 关节脱位 椎弓根钉 锁定板 

分 类 号：R683.2[医药卫生—骨科学]