| Wiltse入路经椎弓根植骨治疗胸腰椎骨折 |
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Received:November 16, 2012
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| 期刊信息：《中国骨伤》2013年26卷，第7期，第587-590页 |
| DOI：10.3969/j.issn.1003-0034.2013.07.014 |
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目的: 探讨Wiltse入路经椎弓根植骨治疗胸腰椎骨折的方法及临床疗效。
方法: 2009年3月至2012年2月,采用Wiltse入路经椎弓根植骨固定手术治疗胸腰段椎体骨折患者56例,其中男36例,女20例;年龄14～55岁,平均41岁;受伤至手术时间2～15 d,平均3 d.致伤原因:高处坠落伤25例,平地滑跌伤7例,交通事故伤20例,重物压砸伤4例。所有患者术前行MRI检查排除病理性骨折,并测量多裂肌与最长肌肌间隙距中线的距离,制定个性化方案,经椎弓根植骨器械采用自制改装套管针(用于椎体成形术).骨折按AO分型:A1型压缩型骨折33例,A2型劈裂骨折5例,A3型爆裂型骨折18例。56例中16例伴有脊髓损伤。术前神经功能损伤按Frankel分级:B级5例,C级2例,D级9例。术前腰痛Denis分级均为P5.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效果。
结果: 56例患者均获随访,时间均超过24个月。末次随访时,神经功能Frankel分级:B级3例,C级2例,D级4例,E级7例。腰痛Denis分级:P1(无痛)32例,P2(偶有微痛,不需治疗)18例,P3(中度痛,偶服药) 6例。伤椎前缘高度由(13.38±4.72) mm增加至(22.18±1.44) mm,Cobb角由(28.39±2.64)°减少至(10.07±3.05)°,术后无断钉、断杆、内固定松动、椎体再压缩等并发症。
结论: Wiltse椎旁入路结合椎弓根植骨应用于胸腰段压缩性骨折,可有效减少术中出血及术后并发症,避免复位后的“蛋壳”椎体。掌握显露途径、制定详细术前计划及早期功能锻炼是治疗成功的关键。 |
| [关键词]:脊柱骨折 手术入路 骨折固定术,内 |
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| Transpedicular bone graft for the treatment of thoracolumbar vertebral fractures through Wiltse approach |
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Abstract:
Objective: To explore methods and therapeutic effects of transpedicular bone graft in treating thoracolumbar fractures through Wiltse approach.
Methods: From March 2009 to February 2012,56 patients with thoracolumbar fractures were treated by transpedicular bone graft through Wiltse approach. Among them,there were 36 males and 20 females,ranging in age from 14 to 55 years old (mean,41 years old). The time from injury to operation from 2 to 15 d(mean,3 d). Twenty-five cases were caused by falling down,7 cases were caused by slipping,20 cases were caused by car accident and 4 cases were caused by crush trauma. MRI was performed before operation to exclude pathological fracture. The distance between multifidus muscle and longissimus to midcourt line was measured. Self-made trocar was applied in operation. According to AO classification,there were 33 cases with type A1 compression fracture,5 cases with type A2 cleavage fracture and 18 cases with type A3 burst fracture. Sixteen cases of the 56 cases combined with spinal cord injury. Based on Frankel neurologic grading system,preoperative neurological function was grade B in 5 cases,grade C in 2 cases,gade D in 9 cases. Preoperative Denis gading were P5. Frankel and lumbago Denis clssification were used to evaluate neurological function and lumbago. The imaging data before,after operation and the latest follow-up were used to evaluate correction vision.
Results: All patients were followed up over 24 months. At the time of the latest follow-up,Frankel B were 3 cases,Frankel C were 2 cases,Frankel D were 4 cases and Frankel E were 7 cases. According to lumbago Denis clssification,P1 (painlessness) were 32 cases,P2(slight pain without treatment) were 18 cases,P3 (moderate pain and taking medicine occasionally) were 6 cases. The anterior vertebral height improved from preoperative (13.38±4.72)mm to postoperative (22.18± 1.44)mm. The Cobb's angle decreased from preoperative (28.39±2.64)° to(10.07±3.05)°。 There were no nails broken,rod broken,internal fixation lossen and vertebral body recompression.
Conclusion: Transpedicular bone graft for thoracolumbar fractures through Wiltse approach can reduce intraoperative blood loss and postoperative complications,and aviod "eggshell" vertebral body. Mastering revealed way,drafting detailed preoperative plan and eariler exercise is the key to the success of treatment. |
| KEYWORDS:Spinal fractures Operative approach 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: | 王想福,王兴盛.Wiltse入路经椎弓根植骨治疗胸腰椎骨折[J].中国骨伤,2013,26(7):587~590 |
| 英文格式: | WANG Xiang-fu,WANG Xing-sheng.Transpedicular bone graft for the treatment of thoracolumbar vertebral fractures through Wiltse approach[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(7):587~590 |
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