| 经伤椎置钉治疗胸腰椎骨折的临床研究 |
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Received:April 13, 2011
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| 作者 | Author | 单位 | Unit | E-Mail |
| 邓万祥 |
DENG Wan-xiang |
中国人民解放军第474医院骨科，新疆 乌鲁木齐 830013 |
Department of Orthopaedics, the 474th Hospital of the CPLA, Urumqi 830013, Xinjiang, China |
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| 赵胡瑞 |
ZHAO Hu-rui |
中国人民解放军第474医院骨科，新疆 乌鲁木齐 830013 |
Department of Orthopaedics, the 474th Hospital of the CPLA, Urumqi 830013, Xinjiang, China |
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| 刘华 |
LIU Hua |
中国人民解放军第474医院骨科，新疆 乌鲁木齐 830013 |
Department of Orthopaedics, the 474th Hospital of the CPLA, Urumqi 830013, Xinjiang, China |
liuhuawjh777@sina.com |
| 董晖 |
DONG Hui |
中国人民解放军第474医院骨科，新疆 乌鲁木齐 830013 |
Department of Orthopaedics, the 474th Hospital of the CPLA, Urumqi 830013, Xinjiang, China |
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| 叶斯波 |
YE Si-bo |
中国人民解放军第474医院骨科，新疆 乌鲁木齐 830013 |
Department of Orthopaedics, the 474th Hospital of the CPLA, Urumqi 830013, Xinjiang, China |
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| 孙虎 |
SUN Hu |
中国人民解放军第474医院骨科，新疆 乌鲁木齐 830013 |
Department of Orthopaedics, the 474th Hospital of the CPLA, Urumqi 830013, Xinjiang, China |
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| 期刊信息：《中国骨伤》2011年24卷，第7期，第541-543页 |
| DOI：10.3969/j.issn.1003-0034.2011.07.003 |
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目的：探讨经伤椎椎弓根置钉复位固定治疗胸腰椎骨折的临床效果。
方法：2006年3月至2009年5月，应用后路短节段固定结合伤椎椎弓根螺钉固定治疗胸腰椎骨折27例，男19例，女8例；年龄24～68岁，平均36岁。致伤原因：交通伤11例，高处坠落9例，重物砸伤5例，其他伤2例。骨折根据Gertibein分类：A1型2例，A2型3例，A3型12例，B1型5例，B2型5例。受伤部位：T11 5例，T12 11例，L1 8例，L2 3例。27例中14例伴有脊髓损伤，神经功能损伤按Frankel分级：B级5例，C级3例，D级6例。术前腰痛Denis分级均为P5.受伤至手术时间：2～15 d,平均4 d.按Frankel分级、腰痛Denis分级对神经功能及腰痛情况进行评估；手术前后及末次随访时通过影像学资料评价矫正及维持复位效果。
结果：27例患者均获随访，时间14～17个月，平均15.5个月。末次随访时，神经功能Frankel分级： B级2例，C级4例，D级3例，E级5例。腰痛Denis 分级：P1(无痛)17例，P2(偶有微痛，不需治疗)8例，P3(中度痛，偶服药)2例。伤椎椎体前缘高度(AVH)与后缘高度(PVH)的比值由术前0.32±0.14增加到术后0.85±0.03;矢状位后凸Cobb角由术前(25.3±7.8)°减少至术后(11.1±1.5)°，差异均有统计学意义(P<0.01).末次随访时，伤椎椎体前后缘高度的比值和后凸Cobb角分别为0.81±0.06和(11.8±1.9)°，与术后比较差异均无统计学意义(P>0.05).无感染、内固定失败、术中神经损伤等并发症。
结论：伤椎置钉是治疗胸腰椎骨折的一种有效方法，可以维持脊柱复位效果。 |
| [关键词]:胸椎 腰椎 脊柱骨折 骨折固定术，内 |
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| Treatment of thoracalumbar fractures with pedicle-screw placement on the level of injured vertebrae |
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Abstract:
Objective: To investigate the clinical results of pedicle-screw placement and reduction on the level of injured vertebrae in treating thoracolumbar fractures.
Methods: From March 2006 to May 2009,27 patients with thoracolumbar fractures were treated with short-segment fixation system and pedicle-screw placement on injured vertebrae through posterior approach. There were 19 males and 8 females with an average age of 36 years old ranging from 24 to 68 years. Eleven patients were injuried by traffic accident,9 patients were injuried by falling from high,5 patients were injuried by crush from weighty object,2 patients were others injuries. Thoracolumbar fractures were classified according to Gertibein classification:2 cases were of type A1,3 cases A2,12 cases A3,5 cases B1,5 cases B2. Among them,14 cases were accompanied with spinal cord injuries,functional assessment of nerves was assessed according to Frankel criteria:5 cases were of grade B,3 cases C,6 cases D. Lumbago according to Denis standard,grade P5 was in all cases. The injured level of 5 cases was in T11,11 cases in T12,8 cases in L1,3 cases in L2. From injury to operation it was 2-15 days with an average of 4 days. The ratio of vertebral height between anterior and posterior border,anteroposterior Cobb angle were compared before and after operation. Function of nerves and index of lumbago were evaluated by Frankel and Denis classification.
Results: All patients were followed up from 14 to 17 months with the mean of 15.5 months. At final follow-up,according to Frankel score system to evaluate function of nerve,2 cases were of grade B,4 case grade C,3 cases grade D,5 cases grade E;according to Denis score system to evaluate index of lumbago,there was P1(without pain) in 17 cases,P2(betweenwhiles minute pain,need not treatment)in 8 cases,P3(moderate pain,betweenwhiles need medication)in 2 cases. The ratio of vertebral height between anterior and posterior border from preoperatively 0.32±0.14 to postoperatively 0.85±0.03(P<0.01);anteroposterior Cobb angle from preoperatively(25.3±7.8)°to postoperatively(11.1±1.5)°(P<0.01). At final follow-up,the ratio of vertebral height between anterior and posterior border,anteroposterior Cobb angle were respectively 0.81±0.06 and(11.8±1.9)°，there was no significant difference between postoperative and at final follow-up(P>0.05). No complications such as infection,internal fixation failure,nerve injuries were found during follow-up.
Conclusion: Posterior short-segment fixation system and pedicle-screw placement on level of injured vertebrae is one kind of effective method in treating thoracolumbar fracture,which can maintain corrective effect and obtain better clinical outcomes. |
| KEYWORDS:Thoracic vertebrae Lumbar vertebrae Spinal fractures Fracture fixation,internal |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 邓万祥,赵胡瑞,刘华,董晖,叶斯波,孙虎.经伤椎置钉治疗胸腰椎骨折的临床研究[J].中国骨伤,2011,24(7):541~543 |
| 英文格式: | DENG Wan-xiang,ZHAO Hu-rui,LIU Hua,DONG Hui,YE Si-bo,SUN Hu.Treatment of thoracalumbar fractures with pedicle-screw placement on the level of injured vertebrae[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(7):541~543 |
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