临床骨科杂志
臨床骨科雜誌
림상골과잡지
JOURNAL OF CLINICAL ORTHOPAEDICS
2014年
2期
140-143
,共4页
戴斌%周克中%戴九明%祁才%王金荣%李道龙%沈海滨
戴斌%週剋中%戴九明%祁纔%王金榮%李道龍%瀋海濱
대빈%주극중%대구명%기재%왕금영%리도룡%침해빈
胸腰椎骨折脱位%椎间植骨融合%椎弓根螺钉%内固定器
胸腰椎骨摺脫位%椎間植骨融閤%椎弓根螺釘%內固定器
흉요추골절탈위%추간식골융합%추궁근라정%내고정기
thoracolumbar fracture dislocation%interbody graft fusion%pedicle screw%internal fixators
目的：探讨椎弓根螺钉固定椎间植骨融合治疗胸腰椎骨折脱位的疗效。方法对21例胸腰椎骨折脱位患者采用椎弓根螺钉固定椎间植骨融合治疗。比较术前、术后1周及3、6、12个月Frankel分级变化，复查X线片和CT三维重建，测量椎间隙前后缘高度、Cobb角、观察植骨融合情况，评价临床效果。结果患者均获随访，时间12～24（14.5±5.2）个月。骨折脱位均获得复位。无神经、血管损伤、内固定松动断裂等并发症。脊髓神经功能均有不同程度恢复。影像学显示椎体间距稳定，植骨在术后3～6个月均获骨性融合。术后1周和3、6、12个月Cobb角分别为-0.12°±1.89°、0.10°±1.92°、0.12°±1.98°、0.14°±2.54°，与术前（22.89°±10.97°）比较差异均有统计学意义（P＜0.01）。椎间隙前、后缘高度术后1周和3、6、12个月分别为：（10.56±6.23）mm、（9.85±5.54）mm，（10.45±5.96）mm、（9.12±5.57）mm，（10.46±6.12）mm、（9.98±5.75）mm，（10.41±6.11）mm、（9.07±6.01）mm；与术前（-3.23 mm ±1.56 mm、1.89 mm ±2.65 mm）比较差异均有统计学意义（P＜0.01）。结论后路椎间融合椎弓根螺钉固定治疗胸腰椎骨折脱位能够提供解剖复位和坚强内固定，达到术后早期稳定和植骨融合的疗效。
目的：探討椎弓根螺釘固定椎間植骨融閤治療胸腰椎骨摺脫位的療效。方法對21例胸腰椎骨摺脫位患者採用椎弓根螺釘固定椎間植骨融閤治療。比較術前、術後1週及3、6、12箇月Frankel分級變化，複查X線片和CT三維重建，測量椎間隙前後緣高度、Cobb角、觀察植骨融閤情況，評價臨床效果。結果患者均穫隨訪，時間12～24（14.5±5.2）箇月。骨摺脫位均穫得複位。無神經、血管損傷、內固定鬆動斷裂等併髮癥。脊髓神經功能均有不同程度恢複。影像學顯示椎體間距穩定，植骨在術後3～6箇月均穫骨性融閤。術後1週和3、6、12箇月Cobb角分彆為-0.12°±1.89°、0.10°±1.92°、0.12°±1.98°、0.14°±2.54°，與術前（22.89°±10.97°）比較差異均有統計學意義（P＜0.01）。椎間隙前、後緣高度術後1週和3、6、12箇月分彆為：（10.56±6.23）mm、（9.85±5.54）mm，（10.45±5.96）mm、（9.12±5.57）mm，（10.46±6.12）mm、（9.98±5.75）mm，（10.41±6.11）mm、（9.07±6.01）mm；與術前（-3.23 mm ±1.56 mm、1.89 mm ±2.65 mm）比較差異均有統計學意義（P＜0.01）。結論後路椎間融閤椎弓根螺釘固定治療胸腰椎骨摺脫位能夠提供解剖複位和堅彊內固定，達到術後早期穩定和植骨融閤的療效。
목적：탐토추궁근라정고정추간식골융합치료흉요추골절탈위적료효。방법대21례흉요추골절탈위환자채용추궁근라정고정추간식골융합치료。비교술전、술후1주급3、6、12개월Frankel분급변화，복사X선편화CT삼유중건，측량추간극전후연고도、Cobb각、관찰식골융합정황，평개림상효과。결과환자균획수방，시간12～24（14.5±5.2）개월。골절탈위균획득복위。무신경、혈관손상、내고정송동단렬등병발증。척수신경공능균유불동정도회복。영상학현시추체간거은정，식골재술후3～6개월균획골성융합。술후1주화3、6、12개월Cobb각분별위-0.12°±1.89°、0.10°±1.92°、0.12°±1.98°、0.14°±2.54°，여술전（22.89°±10.97°）비교차이균유통계학의의（P＜0.01）。추간극전、후연고도술후1주화3、6、12개월분별위：（10.56±6.23）mm、（9.85±5.54）mm，（10.45±5.96）mm、（9.12±5.57）mm，（10.46±6.12）mm、（9.98±5.75）mm，（10.41±6.11）mm、（9.07±6.01）mm；여술전（-3.23 mm ±1.56 mm、1.89 mm ±2.65 mm）비교차이균유통계학의의（P＜0.01）。결론후로추간융합추궁근라정고정치료흉요추골절탈위능구제공해부복위화견강내고정，체도술후조기은정화식골융합적료효。
Objective To investigate the efficacy of pedicle screw fixation with posterior lumbar interbody graft fusion for the treatment of thoracolumbar fracture-dislocation.Methods 21 cases of thoracic lumbar fracture-dislocation were treated by pedicle screw fixation with posterior lumbar interbody graft fusion.Preoperative and postoperative 1 week,3 months,6 months,12 months Frankel grading change were compared.The clinical results was evaluated by review the X-ray and CT reconstruction,measurement around the edge of the disc space height,observation and fu-sion of the Cobb angle.Results All patients were followed up for 12 ~24 months,with an average of 14.5 ±5.2 months.Patients with fracture dislocation were reduced.There were no nerve,vascular damage,fixation loosening and other complications.Spinal cord function got different levels of recovery,radiographic vertebral spacing was stabe,and bone graft in 3~6 months after surgery were bone fusion.After 1 week,3 months,6 months,12 months, Cobb angle was -0.12°±1.89°,0.10°±1.92°,0.12°±1.98°,0.14°±2.54°.The difference was statistically sig-nificant between the preoperative(P<0.01).The altitude of intervertebral anterior and posterior after operation 1 week,3 months,6 months,12 months was (10.56 ±6.23)mm and (9.85 ±5.54)mm,(10.45 ±5.96)mm and (9.12 ±5.57)mm,(10.46 ±6.12)mm and (9.98 ±5.75)mm,(10.41 ±6.11)mm and (9.07 ±6.01)mm;there was statistically significant difference between preoperative(-3.23 mm ±1.56 mm,1.89 mm ±2.65 mm)and postoperative(P<0.01).Conclusions Pedicle screw fixation with posterior lumbar interbody graft fusion for thora-columbar fracture dislocation can provide anatomic reduction and rigid internal fixation to achieve the efficacy of early postoperative stability and interbody bony fusion.
