摘要
目的通过生物力学测试及临床应用对经皮跨伤椎四钉内固定（万向钉固定）与开放手术四钉内固定（单向钉固定）进行比较。方法取12具新鲜冰冻小牛腰椎标本L1～L5节段，随机分为单向钉固定组与万向钉固定组。制备腰椎前中柱损伤模型，比较两组在模型上的运动范围。分别应用Sextant经皮跨伤椎四钉内固定与开放跨伤椎四钉内固定治疗无神经功能损伤的胸腰椎骨折25例和35例，观察其中随访超过12个月的11例和18例的即时复位效果、矫正度丢失情况。结果（1）生物力学试验：万向钉固定组在各个方向的运动范围均大于单向钉固定组，其中在前屈、后伸方向的差异有统计学意义；单向钉固定组在前屈、后伸、侧屈方向上的稳定性较完整标本大，差异有统计学意义；万向钉固定组在前屈、后伸方向上的稳定性与完整标本比较差异无统计学意义。（2）临床应用：两组术前、术后伤椎前缘高度、矢状位Cobb角的组间差异均无统计学意义；两组术后伤椎前缘高度、矢状面Cobb角与术前比较差异均有统计学意义；末次随访时经皮跨伤椎四钉内固定组伤椎前缘高度丢失（9．9％±5．1％）大于开放跨伤椎四钉内固定组（5．3％±6．8％）。结论应用Sextant系统经皮椎弓根螺钉内固定治疗无须神经减压的胸腰椎骨折较开放手术创伤小，但随访中伤椎前缘高度丢失明显。生物力学试验显示其在前屈、后伸运动方向上的强度较弱。
Objective To evaluate the biomechanical stability and the clinical efficacy of the percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures. Methods Twelve lumbar fracture models were made on fresh calf lumbar spine specimens to compare the stability of the 4 monoaxial screws and 4 multiaxial screws transpedicular fixation by examining the range of motion （ROM） in flexion, extension, lateral bending, and torsion. Sixty cases of thoracolumbar fractures without neuro-deficiency were treated surgically, 11 of the minimally invasive group （monoaxial screw group） and 18 of the open surgery group （muhiaxial screw group） were followed up more than 12 months. Results The 4 monoaxial screws transpedicular fixation specimen exhibited a smaller ROM significantly in flexion, extension compared with the 4 muhiaxial screws transpedicular fixation specimen. The 4 monoaxial screws transpedicular fixation specimen exhibited a significantly smaller ROM in flexion and extension than the intact specimens. The ROM in the 4 muhiaxial screws transpedicular fixation specimen and the intact showed on significant differences. There were no significant differences between the two groups in the preoperative and postoperative anterior fractured vertebral height （AVH） and the Cobb＇s angle （CA）, but there were significant differences in the AVH and the CA between preoperative and postoperative in the two groups. There were significant differences in the correction loss of the AVH between the two groups at final follow-up. Conclusion The percutaneous pedicle screw fixation using Sextant system is a good minimally invasive surgical choice for patients with thoracolumbar fractures without neuro-deficiency, but which has a loss of the AVH and worse flexion-extension stiffness in follow-up compared with the open monoaxial screws fixation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2011年第9期932-937,共6页
Chinese Journal of Orthopaedics
关键词
胸椎
腰椎
脊柱骨折
内固定器
生物力学
Thoracic vertebrae
Lumbar vertebrae
Spinal fractures
Internal fixators
Biomechanics
