摘要
目的评价胸腰椎骨折经骨折椎椎弓根螺钉固定的安全性。方法胸腰椎椎体单节段骨折102例,术前行CT加密扫描观察椎弓根的完整性、直径和骨折部位,以确定入钉点、进钉角度和螺钉直径。按置钉椎体的情况分为经正常椎椎弓根置钉组(正常组,204椎)和经骨折椎椎弓根置钉组(骨折组,102椎)。术后以CT扫描评价螺钉置钉的准确性。结果102例患者共置入608枚椎弓根螺钉。骨折组置钉200枚,其中椎弓根螺钉CT位置分级Ⅰ度185枚,Ⅱ度15枚;正常组置钉408枚,其中Ⅰ度387枚,Ⅱ度21枚;两组置钉椎弓根螺钉CT位置分级的差异无统计学意义(x^2=1.33,P>0.05)。术后CT扫描证实,572枚螺钉(94.1%)完全位于椎弓根内;36枚螺钉(5.9%)出现偏差。骨折组置钉有15枚发生位置偏差,偏差率为7.5%,其中8枚偏外,4枚偏下,3枚螺钉直径过大,但均未导致临床不良后果;正常组置钉有21枚发生位置偏差,偏差率为5.1%,其中12枚偏外,7枚偏下,2枚螺钉直径过大;两组偏差率的差异无统计学意义(P>0.05)。结论经骨折椎置入椎弓根螺钉治疗胸腰椎骨折的方法安全、可靠,不增加额外的手术风险。螺钉位置出错多为方向偏外或偏下。
Objective To evaluate the safety of pedicle screw fixation via fractured vertebra in treatment of thoracolumbar vertebra fracture. Methods One hundred and two patients with isolated thoracolumbar vertebra fractures were included in this study. Preoperative CT scans were performed to observe the intactness, the diameter and fracture site of the pedicles and to identify the entrance point and angle of the screws and to confirm the diameters of the screws. All the pedicles were divided into two groups according to whether the pedicles were fractured. There were 102 vertebras in the fractured pedicle group and 204 in normal pedicle group. Postoperative CT scans were performed to evaluate the accuracy of the pedicle screw positions. Results Postoperative CT scans showed that 572 screws （94.1%） were well located among a total of 608 pedicles in 102 patients. The deviation rate of the screws was 5.9 %, with 7.5 % in the fractured pedicle group and 5.1 % in the normal pedicle group. There was no statistical difference in the deviation rates between the two groups（χ^2=：1.33,P〉 0.05）. Among the 15 deviated screws in the fractured pedicle group, 8 had lateral deviation, 4 had downward deviation, and 3 had too large diameter. Among the 21 deviated screws in the normal pedicle group, 12 had lateral deviation, 7 had downward deviation, and 2 had too large diameter. However, none of the deviated screws had caused any clinical symptoms. Conclusion Pedicle screw fixation via fractured vertebra is safe and reliable in the treatment of thoracolumbar vertebral fractures, causing no increase in the extra damage risk. The malposition of the screw, if any, is usually lateral or inferior deviation.
出处
《上海医学》
CAS
CSCD
北大核心
2008年第9期613-616,F0002,共5页
Shanghai Medical Journal
关键词
胸椎
腰椎
骨折
椎弓根钉
骨折固定术
Thoracic vertebra
Lumbar vertebra
Fracture
Pedicle screw
Fractural fixation
