伤椎斜向置钉联合双节段椎间融合治疗单节段严重胸腰椎骨折的疗效分析  

Posterior fixation with inclined-long pedicle screws for the injured vertebra combined with two-level interbody fusion for severe fractures of single level thoracolumbar spine

作　　者：韩尧政 马俊 黄亮亮 苏林涛 雷昌宇 江剑峰 康辉 Han Yaozheng;Ma Jun;Huang Liangliang;Su Lintao;Lei Changyu;Jiang Jianfeng;Kang Hui(Department of Orthopaedics,General Hospital of Central Theater Command,Wuhan 430070,China)

机构地区：[1]中部战区总医院骨科,武汉430070

出　　处：《中华创伤骨科杂志》2024年第7期583-589,共7页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省医学青年拔尖人才项目(鄂卫通(2019)48号);湖北省卫健委面上科研项目(WJ2023M091)。

摘　　要：目的探讨单纯后路伤椎斜向置钉联合双节段椎间融合治疗合并椎间盘严重损伤的单节段胸腰椎爆裂性骨折的疗效。方法回顾性分析2016年6月至2021年6月中部战区总医院骨科收治的22例合并椎间盘严重损伤的单节段胸腰椎爆裂性骨折患者资料。男15例,女7例;年龄43.50(29.75,52.25)岁;骨折按AO分型:B2型12例,C3型10例。均采用后路伤椎斜向置钉联合双节段椎间融合治疗。比较所有患者术前、术后1周、术后3个月及末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎前缘高度比(AVHR)、局部Cobb角(KCA)、伤椎楔形角(VWA)和椎管内占位率(SCER)。根据美国脊髓损伤协会分级评估神经功能改善情况,采用CT三维重建评估椎间融合情况。结果所有患者均获随访,时间(26.1±1.3)个月。术后1周所有患者的疼痛VAS评分和ODI均较术前显著下降,术后3个月和末次随访时较术后1周进一步显著下降,差异均有统计学意义(P<0.05)。术后1周、术后3个月、末次随访时所有患者的AVHR、KCA、VWA、SCER均较术前显著改善,末次随访时SCER较术后1周显著下降,差异均有统计学意义(P<0.05)。末次随访时所有患者神经功能均有不同程度改善,全部椎间隙均获得骨性融合。结论采用单纯后路伤椎斜向置钉联合双节段椎间融合治疗合并椎间盘严重损伤的单节段胸腰椎爆裂性骨折,可以充分解除神经压迫、恢复伤椎高度、重建骨折区域的曲度、椎间融合可靠,疗效满意。ObjectiveTo evaluate the posterior fixation with inclined-long pedicle screws for the injured vertebra combined with two-level interbody fusion for thoracolumbar burst fractures with severe disc injury.MethodsA retrospective study was conducted to analyze the clinical data of 22 patients who had been treated for thoracolumbar burst fractures with severe disc injury at Department of Orthopaedic,General Hospital of Central Theater Command from June 2016 to June 2021.There were 15 males and 7 females,aged 43.50(29.75,52.25)years.By the AO classification,there were 12 cases of type B2,10 cases of type C3.All the patients were treated by the posterior fixation with inclined-long pedicle screws for the injured vertebra combined with two-level interbody fusion.The visual analogue scale(VAS),Oswestry disability index(ODI),anterior vertebral height ratio(AVHR),kyphosis Cobb angle(KCA),vertebral wedge angle(VWA)and spinal canal encroachment rate(SCER)were compared between pre-surgery,1 week post-surgery,3 months post-surgery and the last follow-up.Their neurological function was graded according to the American Spinal Injury Association(ASIA)impairment scale and interbody fusion evaluated according to their 3D CT at the last follow-up.ResultsAll the 22 patients were followed up for(26.1±1.3)months.In all patients,the VAS and ODI were significantly lower at 1 week post-surgery than the pre-surgery ones(P<0.05),and then decreased significantly at 3 months post-surgery and at the last follow-up compared with the values at 1 week post-surgery(P<0.05).For all patients,there were significant improvements in AVHR,KCA,VWA and SCER at 1 week post-surgery,3 months post-surgery and the last follow-up compared with the pre-surgery values(P<0.05),and the SCER at the last follow-up was significantly decreased compared with that at 1 week post-surgery(P<0.05).All patients experienced improved neurological function in different degrees at the last follow-up,and all intervertebral spaces achieved solid bony fusion.ConclusionIn the treatme

关 键 词：脊柱骨折 胸椎 腰椎 椎间盘 伤椎斜向置钉 双节段椎间融合 

分 类 号：R687.3[医药卫生—骨科学]