6枚万向椎弓根钉固定在胸腰椎骨折治疗中的应用  

Application of six universal pedicle screws fixation in the treatment of thoracolumbar fracture

作　　者：厉彦成 刘延晓 饶建伟 李磊[1] 叶舟 王华[1] LI Yan-cheng;LIU Yan-xiao;RAO Jian-wei;LI Lei;YE Zhou;WANG Hua(Dept of Orthopaedics,Quzhou Hospital Affiliated of Wenzhou Medical University,the People′s Hospital of Quzhou City,Quzhou,Zhejiang 324000,China)

机构地区：[1]温州医科大学附属衢州医院(衢州市人民医院)骨科,浙江衢州324000

出　　处：《临床骨科杂志》2023年第5期609-613,共5页Journal of Clinical Orthopaedics

基　　金：浙江省衢州市科技局竞争性项目(编号:2022K57)。

摘　　要：目的探讨6枚万向椎弓根钉固定用于胸腰椎骨折治疗的效果。方法对44例胸腰椎骨折患者经伤椎及上、下邻椎各置入2枚万向椎弓根钉固定。记录骨折愈合时间及手术前后胸腰痛VAS评分、伤椎Cobb角、内固定系统上位及下位邻近节段椎间高度指数、伤椎前缘高度比。结果患者均获得12个月随访。骨折均愈合,时间3~6个月。①胸腰痛VAS评分:术后7 d及1、3、6、12个月均低于术前(P<0.05);术后7 d、1个月、3个月随时间逐渐降低(P<0.05)。②伤椎Cobb角:术后7 d及1、3、6个月均小于术前(P<0.05),术后12个月与术前比较差异无统计学意义(P>0.05);术后1、3、6、12个月均大于术后7 d(P<0.05)。③内固定系统上位邻近节段椎间高度指数:术前及术后7 d、1个月、3个月比较差异均无统计学意义(P>0.05);术后6个月及12个月分别低于术前、术后7 d、术后1个月(P<0.05)。④内固定系统下位邻近节段椎间高度指数:术后7 d明显高于术前(P<0.05),术后1、3个月均低于术后7 d(P<0.05),且与术前比较差异无统计学意义(P>0.05);术后6个月及12个月分别低于术前、术后7 d、术后1个月(P<0.05)。⑤伤椎前缘高度比:术后7 d及1、3、6、12个月均高于术前(P<0.05);术后1、3、6、12个月均低于术后7 d(P<0.05)。结论6枚万向椎弓根钉固定用于胸腰椎骨折的治疗,可显著改善患者胸腰背疼痛,恢复椎体前缘高度,但也存在加快上位椎间盘退变的可能,对术后维持伤椎Cobb角无明显优势。Objective To investigate the effect of 6 universal pedicle screws in the treatment of thoracolumbar fracture.Methods The 44 patients with thoracolumbar fractures were fixed with 2 universal pedicle screws inserted through the injured vertebra,upper and lower adjacent vertebrae,respectively.The following data were recorded,including the fracture healing time,thoracolumbar pain VAS before and after surgery,Cobb angle of the injured vertebra,adjacent segments intervertebral height index of the upper and lower levels of the internal fixation system,and ratio of anterior margin height of the injured vertebrae.Results All patients were followed up for 12 months.All fracture healed within 3~6 months.①thoracolumbar pain VAS:at 7 d and 1,3,6,12 months after surgery,which were lower than those before surgery(P<0.05);at 7 d,1,3 months after surgery,which were gradually decreased with time prolonging(P<0.05).②Cobb angle of injured vertebrae:at 7 d,1,3 and 6 months after surgery,which were smaller than those before surgery(P<0.05),but there was no statistical difference between postoperative 12 months and the preoperation(P>0.05);and at postoperative 1,3,6 and 12 months,which were larger than postoperative 7 d(P<0.05).③The height index of upper adjacent segments of the internal fixation system showed no statistical difference between the preoperation and 7 d,1,3 months after surgery(P>0.05);at 6,12 months after surgery,which was lower than the preoparation,postoperative 7 d,1 month,respectively(P<0.05).④The intervertebral height index of the lower adjacent segments of the internal fixation system:at 7 d after surgery,which was significantly higher than that before surgery(P<0.05),and the data of postoperaive 1,3 months were both lower than that of 7 d postoperation(P<0.05),and there was no statistical significance,compared with before surgery(P>0.05);at 6 and 12 months after surgery,which were lower than those before surgery,postoperative 7 d,1 month,respectively(P<0.05).⑤The ratio of anterior edge height of injured

关 键 词：万向椎弓根钉 胸腰椎骨折 伤椎固定 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]