| 肌间隙入路短节段椎弓根螺钉结合伤椎强化治疗胸腰椎骨折的临床观察 |
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投稿时间：2013-10-15
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| 期刊信息：《中国骨伤》2014年，第27卷，第2期，第97-100页 |
| DOI：10.3969/j.issn.1003-0034.2014.02.003 |
| 基金项目: |
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中文摘要:
目的：观察肌间隙入路短节段椎弓根钉固定结合伤椎强化治疗胸腰椎骨折的临床疗效.
方法：自2009年1月至2012年1月采用肌间隙入路短节段椎弓根螺钉内固定结合伤椎自固化磷酸钙骨水泥椎体强化术治疗无神经损伤表现胸腰椎骨折患者18例（24个椎体），男11例，女7例；年龄52～76岁，平均62.2岁. 受伤至手术时间为8 h～7 d，平均4.2 d.依据Denis分型：压缩型12例，爆裂型6例. 骨折部位：T12 6椎，L1 9椎，L2 6椎，L3 3椎. 对手术前后伤椎前缘高度比、矢状面Cobb角、椎体矢状面指数（sagittal index，SI）、内固定失败情况及后凸畸形再发进行观察.
结果：所有患者获得随访，时间12～28个月，平均16.5个月. 手术时间80～130 min，平均95 min；术中出血量100～180 ml，平均为145 ml.术前、术后3 d及末次随访时的伤椎前缘高度比分别为54.3±2.8、90.9±1.5、88.6±1.7；矢状面Cobb角分别为（27.8±2.5）°、（5.3±0.8）°、（6.3±1.4）°；SI分别为52.3±3.8、89.2±5.2、86.4±4.5.术后3 d较术前明显改善，末次随访与术后3 d比较差异无统计学意义. 没有神经功能损伤、内固定失败及后凸畸形发生.
结论：肌间隙入路短节段椎弓根螺钉固定结合自固化磷酸钙骨水泥伤椎强化治疗胸腰椎骨折创伤小，失血量少，可完整保留脊柱后方复合体结构，同时可有效恢复伤椎前中柱的力学强度，防止内固定失败和椎体再发后凸畸形. |
| 【关键词】脊柱骨折 骨折固定术, 内 椎体后凸成形术 |
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| Treatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach |
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ABSTRACT
Objective: To evaluate the clinical effects of short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach in treating thoracolumbar fractures.
Methods: From January 2009 to January 2012,18 patients with thoracolumbar fractures without neurological symptoms were treated with short-segment transpedicular fixation and vertebroplasty via paraspinal intermuscular approach. There were 11 males and 7 females,aged from 52 to 76 years old with an average of 62.2 years. The duration from injuries to surgery ranged from 8 h to 7 d with an average of 4.2 d. According to the Denis fracture classification,12 cases got compression fractures and 6 cases got burst fractures. Location: 6 vertebra with T12,9 with L1,6 with L2,and 3 with L3. Anterior vertebral body height,the sagittal Cobb angle,the sagittal index(SI),condition of internal fixation failure and recurrent kyphosis were observed.
Results: All patients were followed up for 12-28 months with an average of 16.5 months. Operation time was from 80 to 130 min with a mean of 95 min and bleeding volume during operation ranged from 100 to 180 ml with a mean of 145 ml. Anterior vertebral body height ratios preoperation,3 days after operation and final follow-up was 54.3±2.8,90.9±1.5,88.6±1.7,respectively;sagittal Cobb angle was (27.8±2.5) °,(5.3±0.8) °,(6.3±1.4)°,respectively;sagittal index was 52.3±3.8,89.2±5.2,86.4±4.5,respectively. Data obtained 3 days after operation obviously improved than preoperation,and there was no statistically significant difference between 3 days after operation and last follow-up. No internal fixation failure,neurological complications and recurrent kyphosis were found.
Conclusion: Treatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach can retain the posterior ligament complex and restore the mechanical strength of the anterocentral column,which proved an ideal method for preventing the failure of internal fixation and reduction of post-traumatic segmental kyphosis. |
| KEY WORDS Spinal fractures Fracture fixation,internal Kyphoplasty |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙观荣,韩雷.肌间隙入路短节段椎弓根螺钉结合伤椎强化治疗胸腰椎骨折的临床观察[J].中国骨伤,2014,27(2):97~100 |
| 英文格式: | SUN Guan-rong,HAN Lei.Treatment of thoracolumbar fractures with short-segment transpediclar screw fixation and vertebroplasty via paraspinal intermuscular approach[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(2):97~100 |
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