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高海拔地区应用伤椎置钉技术治疗脊柱爆裂骨折

摘要点击次数: 1483 全文下载次数: 617 投稿时间：2022-04-12

作者	Author	单位	Address	E-Mail
扎西平措	Zhaxipingcuo	西藏自治区定日县人民医院, 西藏自治区日喀则 858200	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China
格桑	Gesang	西藏自治区定日县人民医院, 西藏自治区日喀则 858200	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China
罗杰	Luojie	西藏自治区定日县人民医院, 西藏自治区日喀则 858200	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China
美多	Meiduo	西藏自治区定日县人民医院, 西藏自治区日喀则 858200	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China
旦增欧珠	Danzengouzhu	西藏自治区定日县人民医院, 西藏自治区日喀则 858200	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China
普布顿珠	Pubudunzhu	西藏自治区定日县人民医院, 西藏自治区日喀则 858200	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China
袁军	YUAN Jun	西藏自治区定日县人民医院, 西藏自治区日喀则 858200 上海市松江区泗泾医院, 上海 201601	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China Songjiang District Sijing Hospital, Shanghai 201601, China
章新君	ZHANG Xin-jun	西藏自治区定日县人民医院, 西藏自治区日喀则 858200 上海市松江区泗泾医院, 上海 201601	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China Songjiang District Sijing Hospital, Shanghai 201601, China
黄晓刚	HUANG Xiao-gang	西藏自治区定日县人民医院, 西藏自治区日喀则 858200 上海市松江区泗泾医院, 上海 201601	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China Songjiang District Sijing Hospital, Shanghai 201601, China
戴磊	DAI Lei	西藏自治区定日县人民医院, 西藏自治区日喀则 858200 上海市松江区中心医院, 上海 201600	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China Songjiang District Central Hospital, Shanghai 201600, China
柳超	LIU Chao	西藏自治区定日县人民医院, 西藏自治区日喀则 858200 上海市松江区中心医院, 上海 201600	Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China Songjiang District Central Hospital, Shanghai 201600, China	ortholiuchao@163.com

期刊信息：《中国骨伤》2023年，第36卷，第5期，第450-453页

DOI：10.12200/j.issn.1003-0034.2023.05.011

基金项目:

中文摘要:

目的:针对高海拔地区脊柱爆裂骨折的特点及当地医疗条件,探讨椎弓根螺钉短节段固定联合伤椎置钉技术治疗胸腰椎爆裂骨折的临床疗效。

方法:自2018年8月至2021年12月,采用伤椎置钉技术治疗12例无神经症状的单椎体胸腰椎爆裂骨折患者,其中男7例,女5例;年龄29~54(42.50±7.95)岁;车祸伤6例,高坠伤4例,重物砸伤2例;T₁₁2例,T₁₂4例,L₁3例,L₂2例,L₃1例。手术首先在骨折上下椎置钉,并在伤椎置入椎弓根螺钉,安装连接棒,通过体位及撑开实现骨折椎体复位。应用视觉模拟评分(visual analogue scale,VAS)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估患者疼痛及生活质量改变情况,通过X线测量受伤节段后凸矫正率及矫正丢失率。

结果:所有患者手术顺利,术中无明显并发症,12例患者均获随访,时间9~27(17.75±5.79)个月。术后3 d,VAS与术前入院时相比差异有统计学意义(t=6.701,P=0.000);术后9个月JOA评分与术前入院时相比差异有统计学意义(t=5.085,P=0.000)。术后3 d,Cobb角为(4.42±1.16) °,与术前入院时的(25.67±5.71) °相比矫正率为(82±5)%;术后9个月Cobb角(5.08±1.24) °,矫正丢失率为(16±13)%。无内固定松动及断裂。

结论:高原低气压低氧环境下,应保证手术效果的同时减少创伤,应用伤椎置钉技术能够有效恢复并维持伤椎高度,出血少,固定节段短,是治疗高海拔地区脊柱爆裂骨折的有效方法。

【关键词】高海拔椎弓根螺钉脊柱骨折

Treatment of spinal burst fractures with pedicle screw fixation at high altitude area

ABSTRACT

Objective According to the characteristics of spinal burst fractures in high-altitude areas and the local medical conditions,to explore the clinical efficacy of short-segment fixation with pedicle screws combined with screw placement in injured vertebrae in the treatment of thoracolumbar burst fractures.

Methods From August 2018 to December 2021,12 patients with single-vertebral thoracolumbar burst fractures without neurological symptoms were treated with injured vertebral screw placement technique,including 7 males and 5 females;aged 29 to 54 years old,with an average of(42.50±7.95) years old;6 cases of traffic accident injury,4 cases of high fall injury,2 cases of heavy object injury;2 cases of T₁₁,4 cases of T₁₂,3 cases of L₁,2 cases of L₂,and 1 case of L₃. In the operation,screws were first placed in the upper and lower vertebrae of the fracture,pedicle screws were placed in the injured vertebra,and connecting rods were installed,and the fractured vertebral body was reset by positioning and distraction. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scoring were used to evaluate the changes in pain and quality of life of patients,and the kyphotic correction rate and correction loss rate of the injured segment were measured by X-ray.

Results All operations were successful without significant intraoperative complications. All 12 patients were followed up,the duration ranged from 9 to 27 months,with an mean of (17.75±5.79) months. VAS at 3 days after operation was significantly higher than that at admission (t=6.701,P=0.000). There was significant difference in JOA score between 9 months after operation and at admission (t=5.085,P=0.000). Three days after operation,Cobb angle was (4.42±1.16)°,and the correction rate was (82±5)% compared with (25.67±5.71)° at admission. Cobb angle was (5.08±1.24) åt 9 months after operation,with a corrected loss rate of (16±13)%. No loosening or breakage of internal fixation was found.

Conclusion Under the high-altitude hypobaric and hypoxic environment,the effect of the operation should be ensured while reducing the trauma. The application of the technique of placing screws on the injured vertebra can effectively restore and maintain the height of the injured vertebra,with less bleeding and shorter fixed segments,which is an effective method.

KEY WORDS Altitude Pedicle screw Spinal fractures

引用本文，请按以下格式著录参考文献：

中文格式:	扎西平措,格桑,罗杰,美多,旦增欧珠,普布顿珠,袁军,章新君,黄晓刚,戴磊,柳超.高海拔地区应用伤椎置钉技术治疗脊柱爆裂骨折[J].中国骨伤,2023,36(5):450~453
英文格式:	Zhaxipingcuo,Gesang,Luojie,Meiduo,Danzengouzhu,Pubudunzhu,YUAN Jun,ZHANG Xin-jun,HUANG Xiao-gang,DAI Lei,LIU Chao.Treatment of spinal burst fractures with pedicle screw fixation at high altitude area[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(5):450~453

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