实用医院临床杂志
實用醫院臨床雜誌
실용의원림상잡지
PRACTICAL JOURNAL OF CLINICAL MEDICINE
2015年
3期
7-10
,共4页
封亚平%封雨%唐少锋%谢佳芯%艾卫兵
封亞平%封雨%唐少鋒%謝佳芯%艾衛兵
봉아평%봉우%당소봉%사가심%애위병
胸椎%腰椎%脊柱骨折%椎弓根螺钉%挫伤%神经外科
胸椎%腰椎%脊柱骨摺%椎弓根螺釘%挫傷%神經外科
흉추%요추%척주골절%추궁근라정%좌상%신경외과
Thoracic vcrtebrae%Lumbar vcrtebrae%Spinal fracture%Pedicle screws%Contusion%Neurosurgery
目的：探讨经伤椎椎弓根置钉治疗胸腰椎骨折及合并脊髓损伤（ spinal cord injury ，SCI）早期髓内外减压的手术疗效及安全性。方法1562例胸腰椎骨折患者共计伤椎1316个，对伤椎椎弓根正常者及相邻的上下椎体经椎弓根置钉内固定，手术共完成伤椎置钉2632枚，完全性脊髓损伤（ ASIA评分A级）患者（287例）进行髓内外减压，于术后2周、6个月、12个月复查，观察术后伤椎高度、水平移位、矢状面Cobb角、椎管容积术后增加、伤椎体愈合情况，神经功能恢复、内固定断钉、断棒、镙钉松动等失败率指标。结果全部患者均进行随访。伤椎高度恢复至正常的93．6％，矢状面Cobb角术后恢复至3．1°；术后12月出现断钉4例，断棒5例，无螺钉松动及拔出。术前287例完全性脊髓损伤（ ASIA评分 A级）患者术后12个月A－SIA评分分别为A级113例、B级74例、C级68例、D级26例、E级6例；术前287例ASIA A级患者昆明步行分级（ Kun－ming Locomotor Scale ，KLS）Ⅰ级患者于术后12个月KLS分别为Ⅱ级6例、Ⅲ级11例、Ⅳ级62例、Ⅴ级67例、Ⅵ级84例、Ⅶ级37例、Ⅷ级9例、Ⅸ级5例、Ⅹ级6例；术前不完全性脊髓损伤1225例患者手术后脊髓神经功能均有1～2级的恢复，无神经损伤加重、死亡等并发症。结论经伤椎椎弓根置钉治疗胸腰椎骨折能达到即刻复位，提高了复位质量，改善固定强度及应力分布，大大减少术后断钉、断棒、螺钉松动、拔出、后突畸形的发生概率，对脊髓损伤早期行髓内外减压，提高了手术疗效，是治疗胸腰椎骨折并脊髓损伤安全、有效的方法。
目的：探討經傷椎椎弓根置釘治療胸腰椎骨摺及閤併脊髓損傷（ spinal cord injury ，SCI）早期髓內外減壓的手術療效及安全性。方法1562例胸腰椎骨摺患者共計傷椎1316箇，對傷椎椎弓根正常者及相鄰的上下椎體經椎弓根置釘內固定，手術共完成傷椎置釘2632枚，完全性脊髓損傷（ ASIA評分A級）患者（287例）進行髓內外減壓，于術後2週、6箇月、12箇月複查，觀察術後傷椎高度、水平移位、矢狀麵Cobb角、椎管容積術後增加、傷椎體愈閤情況，神經功能恢複、內固定斷釘、斷棒、鏍釘鬆動等失敗率指標。結果全部患者均進行隨訪。傷椎高度恢複至正常的93．6％，矢狀麵Cobb角術後恢複至3．1°；術後12月齣現斷釘4例，斷棒5例，無螺釘鬆動及拔齣。術前287例完全性脊髓損傷（ ASIA評分 A級）患者術後12箇月A－SIA評分分彆為A級113例、B級74例、C級68例、D級26例、E級6例；術前287例ASIA A級患者昆明步行分級（ Kun－ming Locomotor Scale ，KLS）Ⅰ級患者于術後12箇月KLS分彆為Ⅱ級6例、Ⅲ級11例、Ⅳ級62例、Ⅴ級67例、Ⅵ級84例、Ⅶ級37例、Ⅷ級9例、Ⅸ級5例、Ⅹ級6例；術前不完全性脊髓損傷1225例患者手術後脊髓神經功能均有1～2級的恢複，無神經損傷加重、死亡等併髮癥。結論經傷椎椎弓根置釘治療胸腰椎骨摺能達到即刻複位，提高瞭複位質量，改善固定彊度及應力分佈，大大減少術後斷釘、斷棒、螺釘鬆動、拔齣、後突畸形的髮生概率，對脊髓損傷早期行髓內外減壓，提高瞭手術療效，是治療胸腰椎骨摺併脊髓損傷安全、有效的方法。
목적：탐토경상추추궁근치정치료흉요추골절급합병척수손상（ spinal cord injury ，SCI）조기수내외감압적수술료효급안전성。방법1562례흉요추골절환자공계상추1316개，대상추추궁근정상자급상린적상하추체경추궁근치정내고정，수술공완성상추치정2632매，완전성척수손상（ ASIA평분A급）환자（287례）진행수내외감압，우술후2주、6개월、12개월복사，관찰술후상추고도、수평이위、시상면Cobb각、추관용적술후증가、상추체유합정황，신경공능회복、내고정단정、단봉、라정송동등실패솔지표。결과전부환자균진행수방。상추고도회복지정상적93．6％，시상면Cobb각술후회복지3．1°；술후12월출현단정4례，단봉5례，무라정송동급발출。술전287례완전성척수손상（ ASIA평분 A급）환자술후12개월A－SIA평분분별위A급113례、B급74례、C급68례、D급26례、E급6례；술전287례ASIA A급환자곤명보행분급（ Kun－ming Locomotor Scale ，KLS）Ⅰ급환자우술후12개월KLS분별위Ⅱ급6례、Ⅲ급11례、Ⅳ급62례、Ⅴ급67례、Ⅵ급84례、Ⅶ급37례、Ⅷ급9례、Ⅸ급5례、Ⅹ급6례；술전불완전성척수손상1225례환자수술후척수신경공능균유1～2급적회복，무신경손상가중、사망등병발증。결론경상추추궁근치정치료흉요추골절능체도즉각복위，제고료복위질량，개선고정강도급응력분포，대대감소술후단정、단봉、라정송동、발출、후돌기형적발생개솔，대척수손상조기행수내외감압，제고료수술료효，시치료흉요추골절병척수손상안전、유효적방법。
Objective To investigate the efficacy and safety of internal fixation surgery with screws through intact pedicle of fractured vertebral arch and internal and external spinal cord decompression in the treatment of thoracolumbar spine fractures with acute spinal cord injury (SCI).Methods Of 1562 patients with thoracolumbar spine fractures ,there were 1316 cases with fractured verte-bras.Internal fixation was performed with screws through intact pedicle of fractured and its upper and lower vertebras arches .A total of 2632 screws were fixed .An early internal and external spinal cord decompression was done to 287 patients who were estimated as class A by using ASIA score .All the patients were reexamined at 2 weeks ,6 months and 12 months after surgery .The fractured vertebras height,lateral dislocation,Cobb’s angle on sagittal plane,vertebral canal volume,healing condition,neural functional recovery and rate of internal fixation failure were observed .Results All the patients were followed up after surgery .The heights of the fractured vertebras were improved to 93.6%of the normal value .The Cobb’s angles on sagittal plane were restored to 3.1°.There were 4 cases with broken screw and 5 cases with broken rod after 12 months of surgery while no screw loosening or extraction was observed .The 287 patients with class A were recovered to different extent after 12 months of surgery ,in which 113 cases were class A ,74 cases class B ,68 cases class C,26 cases class D and 6 cases class E.Meanwhile,the 287 patients were scored as class Ⅰ according to Kunming Locomotor Scale (KLS).After surgery,KLS for these cases were improved including 6 cases with class Ⅱ,11 cases with class Ⅲ,62 cases with classⅣ,67 cases with class Ⅴ,84 cases with class Ⅵ,37 cases with class Ⅶ,9 cases with class Ⅷ,5 cases with class Ⅸand 6 cases with class Ⅹ.The 1225 patients with incomplete SCI also achieved 1 to 2 grade of improvement in KLS .Among all cases ,no neurological ag-gravation and death was observed .Conclusion In the treatment of thoracolumbar spine fractures ,internal fixation surgery with screws through intact pedicle of fractured vertebral arch can achieve the instant reduction ,thus,improve the reduction quality ,as well as im-prove the fixation strength and stress distribution ,and dramatically decrease the possibility of internal fixation failure and kyphosis de-formity.Meanwhile,the early internal and external spinal cord decompression can also improve the clinical effectiveness of the surgery . Therefore,the early treatment strategy is a safe and effective therapy to treat thoracolumbar spine fractures with acute SCI .
