CAJ | 학술논문

目的探寻 T11肋椎角大小对 L1椎爆裂骨折前路手术置钉的影响及其与侧方成角的关系.方法分析2006年12月至2010年9月经前路手术治疗资料完整的76例 L1椎体爆裂骨折.其中男48例,女28例;年龄15~68岁,平均(38.45±18.49)岁.损伤椎体均为 L1椎体.致伤原因:高处坠落伤47例,车祸伤23例,重物砸伤6例.损伤至入院时间2 h 至24天,中位数24 h;损伤至手术时间2~17天,中位数6天.脊髓损伤按 Frankel 分级,A级13例,B级9例,C级14例,D级20例,E级20例.手术固定范围:T12~L2固定64例,T12~L1固定12例.手术前后常规拍摄损伤节段为中心的脊柱正侧位片.肋椎角是脊柱正位像的中轴线与 T12椎体上终板的延长线在手术侧(如左侧)第11肋骨的交会点与 T11椎体左上角的连线之间的夹角.冠状面 Cobb’s 角测量方法为固定螺钉所在的上位椎体的上终板延长线与固定螺钉所在的下位椎体的下终板延长线的交角,而不是伤椎的上位椎体上终板延长线与伤椎的下位椎体的下终板延长线的交角.以肋椎角的平均值为基点分为两组,分别是<60°组和>60°组.测量比较两组的冠状面 Cobb’s 角及椎体螺钉与相应终板的夹角(A、B、C、D角为从头端至尾端的4枚椎体螺钉分别与相应椎体终板的夹角),比较肋椎角与椎体螺钉A、B角及术后冠状面 Cobb’s 角之间的差异,并进行线性回归分析.结果<60°组36例,>60°组40例,两组的术后冠状面 Cobb’s 角、椎体螺钉A角、椎体螺钉B角差异均无统计学意义( P>0.05);术后 Cobb’s 角、A、B角与肋椎角的大小没有相关性( P>0.05).结论 T11肋椎角的大小即第11肋骨的倾斜程度与术后冠状面 Cobb’s 角及椎体螺钉置钉的角度之间没有相关性.
목적탐심 T11륵추각대소대 L1추폭렬골절전로수술치정적영향급기여측방성각적관계.방법분석2006년12월지2010년9월경전로수술치료자료완정적76례 L1추체폭렬골절.기중남48례,녀28례;년령15~68세,평균(38.45±18.49)세.손상추체균위 L1추체.치상원인:고처추락상47례,차화상23례,중물잡상6례.손상지입원시간2 h 지24천,중위수24 h;손상지수술시간2~17천,중위수6천.척수손상안 Frankel 분급,A급13례,B급9례,C급14례,D급20례,E급20례.수술고정범위:T12~L2고정64례,T12~L1고정12례.수술전후상규박섭손상절단위중심적척주정측위편.륵추각시척주정위상적중축선여 T12추체상종판적연장선재수술측(여좌측)제11륵골적교회점여 T11추체좌상각적련선지간적협각.관상면 Cobb’s 각측량방법위고정라정소재적상위추체적상종판연장선여고정라정소재적하위추체적하종판연장선적교각,이불시상추적상위추체상종판연장선여상추적하위추체적하종판연장선적교각.이륵추각적평균치위기점분위량조,분별시<60°조화>60°조.측량비교량조적관상면 Cobb’s 각급추체라정여상응종판적협각(A、B、C、D각위종두단지미단적4매추체라정분별여상응추체종판적협각),비교륵추각여추체라정A、B각급술후관상면 Cobb’s 각지간적차이,병진행선성회귀분석.결과<60°조36례,>60°조40례,량조적술후관상면 Cobb’s 각、추체라정A각、추체라정B각차이균무통계학의의( P>0.05);술후 Cobb’s 각、A、B각여륵추각적대소몰유상관성( P>0.05).결론 T11륵추각적대소즉제11륵골적경사정도여술후관상면 Cobb’s 각급추체라정치정적각도지간몰유상관성.
Objective To explore the effects of costovertebral angle of T11 on the screw fixation via anterior approach for L1 burst fractures, and its corelation with the lateral angulation. Methods 76 patients with L1 burst fractures were treated with surgeries via anterior approach from December 2006 to September 2010, whose complete data were analyzed. There were 48 males and 28 females, with an average age of ( 38.45±18.49 ) years old ( range;15-68 years ). These cases were all damaged in L1. The mechanism of injuries were falling from height in 47 cases, traffic accidents in 23 cases and bruise injuries caused by heavy objects in 6 cases. The time from injury to hospital admission was ranged from 2 hours to 24 days, with the median duration of 24 hours. The time from injury to operation was ranged from 2 days to 17 days, with the median duration of 6 days. According to the Frankel assessment for neurological status, 13 cases were at grade A, 9 cases at B, 14 cases at C, 20 cases at D and 20 cases at E. The fixation and fusion segments were T12-L2 in 64 cases and T12-L1 in 12 cases. The digital radiography of anterioposterior and lateral films was routinely shot before and after the operation, with the injury segments in center. The costovertebral angle was the included angle between the medial axis of anterioposterior film of the spine and the line which connected the upper left corner of T11 vertebrae and the intersection of the 11th rib and the extension line of the superior end plate of T12 vertebrae in the operated side (e.g. the left side). The coronal Cobb’s angle was the included angle between the extension line of the superior end plate of the superior vertebra in which the screws were located and the extension line of the inferior end plate of the inferior vertebra in which the screws were located, but not the included angle between the extension line of the superior end plate of the fractured superior vertebra and the extension line of the inferior end plate of the fractured inferior vertebra. According to the mean of the costovertebral angle, the patients could be divided into 2 groups: less than 60° group and more than 60° group. The coronal Cobb’s angle and the included angle between the screws and matching end-plates in both groups were measured and compared. The angles of A, B, C and D were the included angles between the screws in vertebral bodies from the cephalic to the caudal portion and the matching end-plates. The differences among the costovertebral angle, the angles of A and B and the postoperative coronal Cobb’s angle were compared, and the linear regression analysis was carried out. Results There were 36 cases in less than 60° group and 40 cases in more than 60° group. The differences among the postoperative coronal Cobb’s angle, angle A and angle B were not statistically significant between the 2 groups ( P>0.05 ). The postoperative Cobb’s angle, angle A and angle B were not correlated closely with the costovertebral angle ( P>0.05 ). Conclusions There is no correlation among the postoperative coronal Cobb’s angle and the inserting angle of vertebral screws and the costovertebral angle of T11 ( the inclination of the 11th rib ).