胸腰椎骨折不同分型选择性融合的临床疗效  

Clinical efficacy of selective fusion for different types of thoracolumbar fractures

作　　者：郑笑臣 徐永辉[1] 胡军华[1] 高利峰[1] 刘雅普[1] 李鹏[1] 王松茂[1] 侯秀伟[1] ZHENG Xiaochen;XU Yonghui;HU Junhua;GAO Lifeng;LIU Yapu;LI Peng;WANG Songmao;HOU Xiuwei(Department of Spinal Surgery,the Second Hospital Affiliated to Luohe Medical College,Luohe 462300,Henan,China)

机构地区：[1]漯河医学高等专科学校第二附属医院脊柱外科,河南漯河462300

出　　处：《右江医学》2020年第3期172-178,共7页Chinese Youjiang Medical Journal

基　　金：河南省漯河市青年拔尖人才项目(2018NBJRC01004)。

摘　　要：目的依据胸腰椎骨折分型系统,在临床植骨融合治疗胸腰椎骨折方面提出具体分类。方法于2013年9月~2018年8月期间收治的367例胸腰椎骨折患者中,对骨折主要集中在T12~L2区域,基于DR/CT/MRI骨折影像学表现,选择椎体压缩程度超过50%,后纵韧带复合体损伤,后凸角度大于20°,椎间隙改变,椎间盘损伤,部分合并神经脊髓损伤的患者纳入研究范围。选取其中126例患者作为研究对象,男性92例,女性34例,年龄18~62岁,平均(45.2±11.3)岁。依据4种损伤类型行选择性植骨融合,Ⅰ型:上下终板及椎间盘完整,不需要融合,单纯恢复椎体高度;Ⅱ型:骨折累及上终板及上位椎间盘,选择伤椎上关节突、椎板及横突间行植骨融合,保留下关节突活动度;Ⅲ型:骨折累及下终板及下位椎间盘,选择伤椎下关节突、椎板及横突间行植骨融合,保留上关节突活动度;Ⅳ型:骨折累及上下终板及椎间盘,将伤椎上下关节突、椎板及横突间行植骨融合。观察比较各型患者的手术时间、手术出血量、术后引流量的差异,并比较各型骨折手术前后椎体压缩率、Cobb角恢复情况、术后融合率,以及内固定取出后各型伤椎融合与非融合矢状位椎间隙Cobb角的改变情况。结果患者均顺利完成手术,切口Ⅰ期愈合,各型骨折患者手术时间、手术出血量、术后引流量比较有统计学意义(P<0.05);Ⅱ型、Ⅲ型、Ⅳ型患者术后融合率均在90.0%以上;术后各型骨折椎体Cobb角均明显小于术前(P<0.001),取出内固定后,Ⅱ型、Ⅲ型非融合与融合节段伤椎上下椎间隙Cobb角纠正有明显改变(P<0.001)。获得随访116例,随访时间1~2年,平均1.5年。随访期间未见断钉、断棒等情况发生。结论依据胸腰椎骨折分型系统融合治疗后,既保留伤椎部分运动单元减少退变,又能使伤椎融合稳定,减少内固定取出后再后凸及不稳的发生率,此分型系统简明易于记忆,有利于�Objective According to the standard for the classification of thoracolumbar fractures,the clinical types of thoracolumbar fractures were established.Methods In 367 patients with thoracolumbar fractures,the main fractures location was T10-L2 based on DR/CT/MRI fracture imaging.The fracture compression degree is more than 50%,the posterior longitudinal ligament complex was damaged,and the kyphosis angle was greater than 20 degrees combined with disc damage.According to these standard,126 patients were selected as the study subjects,and among them there were 92 males and 34 females who were aged from 18-62 years,with an average age of(45.2±11.3)years.The damages were divided into 4 types:typeⅠ(The upper and lower endplates and the intervertebral disc are intact,no fusion is required,and only the height of the vertebral body is restored.),typeⅡ(Upper endplate and intervertebral disc injury,selective fusion of superior articular processes,retention of inferior articular processes.),typeⅢ(Lower endplate and intervertebral disc injury,selective fusion of inferior articular processes,retention of superior articular processes.),typeⅣ(Upper and lower endplates and intervertebral disc injuries,fusion of superior and inferior articular processes.)The evaluation indicators included operation time,surgical bleeding volume,postoperative drainage volume,fracture vertebral compression rate and Cobb angle recovery degree,postoperative fusion rate,and activity in the adjacent stage after internal fixation.Results All patients underwent surgery successfully.The operation time,surgical bleeding volume,postoperative drainage volume and visual score VAS scores were statistically different(P<0.05).The fusion rate of the fusion group was over 90.0%,Cobb angle less than preoperative(P<0.001),after removal of internal fixation,there was activity near the unfused segment,and the fusion segment.There were statistical differences between these groups(P<0.001).116 patients were followed up for 1-2 years with an average of 1.5 years.No

关 键 词：胸腰椎骨折 选择性融合 骨折分型 

分 类 号：R683.2[医药卫生—骨科学]