伤椎不同部位局部伤对青壮年胸腰椎爆裂性骨折患者行短节段经伤椎固定术后矫正度丢失的影响  

Influence of local injury in different parts of injured vertebra on the loss of correction degree of thoracolumbar burst fracture patients after short segment fixation

作　　者：林华波[1] 丁勇[1] 孟宪志[1] 王朝霞[1] 刘殿鹏[1] LIN Hua-bo;DING Yong;MENG Xian-zhi;WANG Zhao-xia;LIU Dian-peng(The Sixth People's Hospital of Anyang,Anyang,Henan 455000,China)

机构地区：[1]河南省安阳市第六人民医院,河南安阳455000

出　　处：《颈腰痛杂志》2020年第5期588-592,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的观察青壮年胸腰椎爆裂性骨折患者行后路经伤椎置钉内固定手术的疗效,并探讨术后矫正度丢失与伤椎局部椎间盘、终板和前后纵韧带等损伤的相关性。方法纳入2016年9月-2018年9月采用后路短节段经伤椎置钉内固定手术治疗的37例青壮年胸腰椎爆裂性骨折患者作为观察对象,术后获访时间均>1年。研究方法:(1)术前采用MRI检查其骨折节段的前纵韧带、后纵韧带、上下椎间盘和终板的损伤情况;(2)术后即刻和术后1年,采用X线片测量其后凸Cobb角、椎间盘高度、上椎间盘角度、椎体楔形角和椎体高度等影像学参数,计算上述参数的矫正丢失度=术后值-术后1年值。对术前骨折节段相关结构损伤与术后矫正丢失度的相关性进行分析。结果前纵韧带、后纵韧带、下椎间盘/终板损伤及骨折部位,对术后各项影像学参数的矫正丢失度均无显著影响(P>0.05);而伴有上椎间盘-终板复合体损伤者,术后Cobb角和椎体楔形角的矫正度丢失更为显著(P<0.05)。结论青壮年胸腰椎爆裂性骨折若伴有上椎间盘-终板复合体损伤,易造成经伤椎固定术后Cobb角和椎体楔形角的矫正度明显丢失。Objective To observe the efficacy of posterior transvertebral screw placement and internal fixation for thoracolumbar burst fractures in young adults,and to investigate the correlation between the loss of orthodontic degree and the injuries of local intervertebral disc,endplate and anterior and posterior longitudinal ligaments.Methods From September 2016 to September 2018,37 young adults with thoracolumbar burst fracture who were treated by posterior short segment internal fixation were included as the observation subjects,and the patients were followed up for more than 1 year.The study plan was as follows:(1)Preoperative MRI was used to examine the injuries of the anterior longitudinal ligament,posterior longitudinal ligament,upper and lower intervertebral disc and endplate of the fracture segment;(2)Immediately after operation and 1 year after operation,X-ray film was used to measure the imaging parameters such as Cobb angle of kyphosis,disc height,upper disc angle,wedge angle of vertebral body and vertebral body height.The correction loss degree of the above parameters was calculated as postoperative value–value at 1 year after operation.The relationship between the degree of loss of correction and the degree of injury of fracture related structures was analyzed.Results The injuries of the anterior longitudinal ligament,posterior longitudinal ligament,lower intervertebral disc/endplate and the fracture site had no significant effect on the correction loss degree of various postoperative imaging parameters(P>0.05).The injury of the intervertebral disc-endplate complex had a significant effect on the loss of correction of Cobb angle and vertebral wedge angle(P<0.05).Conclusion If the thoracolumbar burst fracture in young adults with intervertebral disc-endplate complex damage,easy to cause the injured vertebra fixed Cobb angle and postoperative vertebral wedge angle correction degree obviously lost.

关 键 词：胸腰椎爆裂性骨折 椎弓根钉 经伤椎置钉 矫正度丢失 上椎间盘-终板损伤 

分 类 号：R683.2[医药卫生—骨科学]