摘要
目的通过观察不同椎弓根骨折类型的植钉情况并与传统跨伤椎植钉比较，初步探讨经伤椎植钉治疗胸腰椎骨折的安全性。方法选取2008年6月-2011年6月收治的符合选择标准的单节段胸腰椎骨折101例，根据治疗方法不同分为2组，A组56例行伤椎植钉，B组45例行跨伤椎植钉。两组患者在性别、年龄、致伤原因、骨折类型、骨折节段、Franke1分级、受伤至手术时间及术前椎体前缘高度压缩比、椎管侵占率等一般资料比较，差异均无统计学意义（P〉0．05）。A组伤椎椎弓根骨折类型分为椎弓根与椎体结合处骨折（Ⅰ型34例）、椎弓根腰部骨折（Ⅱ型2例）、椎弓根与椎板结合处骨折（Ⅲ型20例），观察A组术后伤椎椎弓根螺钉情况，统计两组患者椎管侵占率、椎体前缘高度压缩比、术后并发症及神经功能恢复情况。结果A组Ⅱ型骨折伤椎未植钉，余54例植钉103枚；96枚螺钉位置满意，7枚出现偏差。A组手术时间显著长于B组（t=-4．339，P=0．000），但术中出血量差异无统计学意义（t=-0．089，P=0．929）。101例均获随访，随访时间6～16个月，平均8．5个月。两组患者神经功能均有不同程度恢复。术后A、B组各1例出现内固定物并发症，并发症发生率比较差异无统计学意义（P=1．000）。末次随访时按Denis腰痛分级：A组P1级51例，P2级5例；B组P1级35例，P2级8例，P3级2例；两组比较差异无统计学意义（Z=-1．836，P=0．066）。两组术后即刻及末次随访时椎管侵占率比较，差异均无统计学意义（P〉0．05）；术后即刻椎体前缘高度压缩比差异无统计学意义（P〉0．05），末次随访时B组显著高于A组（P〈0．05）。结论单节段胸腰椎骨折采用后路伤椎植钉治疗，根据不同椎弓根骨折类型指导植钉，不增加手术并发症，安全可行。
Objective To investigate the security of pedicle screw fixation in fractured vertebra in treatment of thoracolumbar fractures by comparing with routine fixation cross fractured vertebra. Methods A total of 101 cases of single segmental thoracolumbar fracture were selected between June 2008 and June 2011. Of them, 56 cases underwent pedicle screw fixation in fractured vertebra （group A）, and 45 cases received routine fixation cross fractured vertebra （group B）. There was no significant difference in gender, age, causes of injury, fracture type, fracture segment, Frankel grading, time of injury to operation, and the preoperative anterior vertebral height compression ratio and the canal occupation rate between 2 groups （P 〉 0.05）. There were 34 cases of junction fracture of pedicle and vertebra （type I）, 2 cases of pedicle waist fracture （type II）, and 20 cases of junction fracture of pedicle and lamina （type III） in group A. The position of fractured vertebral pedicle screw was observed; the anterior vertebral height compression ratio, canal occupation rate, and surgical complications were compared between 2 groups. Results A total of 103 pedicle screws were placed in 54 patients of group A, except 2 patients of type II fracture; 96 screws were placed in the bone cortex completely and 7 screws deviated. The operation time of group A was significantly longer than that of group B （t=4.339, P=0.000）, but there was no significant difference in intraoperative blood loss between 2 groups （t= -0.089, P=0.929）. All 101 patients were followed up 6-16 months （mean, 8.5 months）. The patients of 2 groups achieved nerve functional recovery. Fixation-related complications occurred in 1 case of 2 groups respectively, showing no significant difference （P=1.000）. At last follow-up, according to Denis lumbago classification, 51 cases were rated as P1 level and 5 cases as P2 level in group A; 35 cases were rated as P1 level, 8 cases as P2 level, and 2 cases as P3 level in group B; and there was no significant difference between 2 groups （Z= -1.836, P=0.066）. There was no significant difference between 2 groups in canal occupation rate at immediate after operation and at last follow-up （P 〉 0.05）, and in the anterior vertebral height compression ratio at immediate after operation （P 〉 0.05）, but the anterior vertebral height compression ratio of group B was significantly higher that of group A at last follow-up （P 〈 0.05）. Conclusion Single segmental thoracolumbar fracturetreated by pedicle screw fixation in fractured vertebra through posterior approach is safe and feasible according to different pedicle fracture types to guide fixation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第6期723-727,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省卫生厅科研项目(080424)~~
关键词
胸腰椎骨折
椎弓根骨折
伤椎植钉
Thoracolumbar fracture Pedicle fracture Pedicle screw fixation in fractured vertebra
