自制椎管内骨块复位器在胸腰椎爆裂骨折椎弓根钉内固定术中的应用  

Application of self-made spinal canal fracture block reducer in pedicle screw fixation for thoracolumbar burst fractures

作　　者：秦谊[1] 曾本强 潘梦思 李峰 秦思 常瑞 宋小强[1] 胡兵[1] 陈安刚[1] 李想 胡骅 廖真宇 张凯 QIN Yi;ZENG Ben-qiang;PAN Meng-si;LI Feng;QIN Si;CHANG Rui;SONG Xiao-qiang;HU Bing;CHEN An-gang;LI Xiang;HU Hua;LIAO Zhen-yu;ZHANG Kai(Department of Orthopaedics,Wenjiang Branch of Sichuati Provincial People's Hospital,Chengdu,Sichuan 611130,China)

机构地区：[1]成都市温江区人民医院骨科,四川611130 [2]四川省骨科医院 [3]四川省八一康复中心医院

出　　处：《中国骨与关节损伤杂志》2020年第1期6-9,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察并评价自制椎管内骨块复位器在后路椎弓根钉内固定治疗胸腰椎爆裂骨折术中的应用效果。方法纳入自2016-01—2017-12采用后路椎弓根钉内固定撑开复位并椎板减压术治疗的40例胸腰椎爆裂骨折,20例术中采用自制椎管内骨块复位器复位椎管内骨折块(观察组),20例术中采用常规器械复位椎管内骨折块(对照组)。比较2组末次随访时脊髓神经功能ASIA分级、疼痛VAS评分、伤椎Cobb角、GQOL-74评分。结果 40例均获得至少12个月随访。观察组术后仅出现1例(5%)尿潴留,对照组出现6例(33%)并发症(1例脑脊液漏,1例硬脊膜撕裂,1例医源性神经损伤,3例尿潴留),观察组并发症发生率低于对照组,差异有统计学意义(P <0.05)。观察组末次随访时脊髓神经功能ASIA分级、疼痛VAS评分、伤椎Cobb角、生活质量GQOL-74评分均优于对照组,差异有统计学意义(P <0.05)。结论自制椎管内骨块复位器能有效复位胸腰椎爆裂骨折患者椎管内占位的骨折块,有利于促进患者神经功能恢复,矫正后凸畸形,并且可以降低并发症发生概率,提高患者生活质量。Objective To observe and evaluate the effects of self-made spinal canal fracture blocks reducer in pedicle screw fixation.Methods Forty cases of thoracolumbar burst fractures with fracture blocks occupying the spinal canal were retrospectively analyzed between January 2016 and December 2017.In the observation group,20 patients underwent posterior pedicle screw fixation and open reduction and laminectomy with self-made spinal canal fracture blocks reducer.In the control group,20 patients underwent posterior pedicle screw fixation and open reduction and laminectomy with conventional instruments.The ASIA grade,VAS score,kyphosis Cobb angle and GQOL-74 score were compared at the last follow-up between the two groups.Results Forty patients were followed up for at least 12 months.There was only 1 case(5%)of urinary retention in the observation group while complications occurred in 6 cases(33%)in the control group(1 case of cerebrospinal fluid leakage,1 case of dural tear,1 cases of iatrogenic nerve injury,3 cases of urinary retention).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P>0.05).At the last follow-up,the ASIA grade,VAS score,and Cobb angle in the observation group were better than those in the control group,and the difference were statistically significant(P<0.05).Before surgery,there was no significant difference in GQOL-74 score between the two groups(P>0.05).Conclusion The self-made spinal canal bone block reducer can effectively reduce the fracture of the spinal canal in patients with thoracolumbar burst fracture,which is beneficial to promote the recovery of neurological function,correct vertebral deformity,and reduce the probability of complications and improve patient quality of life.

关 键 词：胸腰椎爆裂骨折 椎管内占位骨块 复位器 椎弓根钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]