开窗型夯实器在胸腰椎爆裂性骨折中的应用  

Application of fenestration rammer in thoracolumbar burst fracture

作　　者：曾俊[1] 林旭[1] 王翔宇 袁德超 谭伦[1] ZENG Jun;LIN Xu;WANG Xiangyu;YUAN Dechao;TAN Lun(Section 1,Department of Orthopedics,Zigong Fourth People's Hospital,Zigong,Sichuan 64300,P.R.China)

机构地区：[1]自贡市第四人民医院骨一科,四川自贡643000

出　　处：《华西医学》2022年第9期1328-1333,共6页West China Medical Journal

基　　金：四川省卫生健康委员会科研项目(19PJ309)。

摘　　要：目的观察并评价新型开窗型夯实器在后路内固定复位椎板有限开窗减压治疗胸腰椎爆裂性骨折中的临床疗效。方法回顾性选择2017年9月—2020年1月自贡市第四人民医院收治的胸腰椎爆裂性骨折患者。根据手术方式不同分为观察组和对照组。其中,观察组采用单侧椎板有限开窗新型夯实器复位椎管内骨折块,对照组采用常规器械复位椎管内骨折块。随访记录两组患者手术时间、术中出血量,CT测量椎管矢状径比值,术后椎体“空壳现象”的发生例数,并对其脊髓神经功能进行Frankel分级评价。结果共纳入患者67例。其中,观察组33例,对照组34例。两组患者均获随访,随访时间12~16个月,平均(14.45±2.25)个月。两组Frankel分级改善率均为100%。除术前椎管矢状径比值(P=0.616)外,对照组和观察组的手术时间[(150.44±26.47)vs.(120.91±20.86)min]、术中出血量[(244.41±42.97)vs.(183.33±34.56)mL]、术后1周椎管矢状径比值[(92.50±2.32)%vs.(93.72±2.40)%]、末次随访椎管矢状径比值[(91.50±2.96)%vs.(93.17±3.27)%]、出现“空壳现象”(13 vs.5例)比较,差异均有统计学意义(P<0.05)。两组组内术后1周、末次随访的椎管矢状径比值均较术前改善(P<0.05);术后1周、末次随访的椎管矢状径比值比较,差异无统计学意义(P>0.05)。结论新型开窗型夯实器能够有效复位胸腰椎爆裂性骨折椎管内占位骨折块,能够有效恢复椎管容积,达到减压目的,同时有效预防了椎体空壳形成,最大限度保留了后柱稳定结构,没有出现医源性神经损伤,安全有效。Objective To observe and evaluate the clinical effect of the new fenestration rammer in the treatment of thoracolumbar burst fracture by posterior internal fixation and reduction of lamina with finite fenestration decompression.Methods Patients with thoracolumbar burst fractures admitted to Zigong Fourth People’s Hospital between September 2017 and January 2020 were retrospectively selected.The patients were divided into observation group and control group according to different surgical methods.The observation group used a new tamping device with finite fenestration rammer of unilateral lamina to reduce the spinal occupying bone mass,and the control group used conventional instruments for reduction of intraspinal fracture masses.The operation time,intraoperative blood loss,CT measurement of sagittal diameter ratio of spinal canal and the number of cases of postoperative vertebral empty shell phenomenon were recorded in the two groups,and Frankel grading evaluation of spinal nerve function was conducted.Results A total of 67 patients were included.There were 33 cases in the observation group and 34 cases in the control group.The patients in both groups were followed up for 12 to 16 months,with an average of(14.45±2.25)months.The improvement rate of Frankel rating in each group was 100%.In the control group and the observation group,except for the sagittal diameter ratio of spinal canal before operation(P=0.616),the operation time[(150.44±26.47)vs.(120.91±20.86)min],the intraoperative blood loss[(244.41±42.97)vs.(183.33±34.56)mL],the sagittal diameter ratio of spinal canal one week after operation[(92.50±2.32)%vs.(93.72±2.40)%],the sagittal diameter ratio of spinal canal at the last follow-up[(91.50±2.96)%vs.(93.17±3.27)%]and the occurrence of empty shell phenomenon(13 vs.5 cases)were statistically significant(P<0.05).The intragroup comparison showed that the sagittal diameter ratio of spinal canal was improved one week after operation and at the last follow-up compared with that before operation(P<0.05

关 键 词：胸腰椎爆裂性骨折 有限开窗 减压 椎管内占位骨块 夯实器 

分 类 号：R687.3[医药卫生—骨科学]