摘要
目的探讨对存在不同程度骨质疏松的脊柱胸腰段爆裂型骨折的中老年患者，采用椎弓根系统治疗的方法；并根据其特点，采取相应的措施，以提高手术疗效。方法共治疗&)例脊柱胸腰段爆裂型骨折的中老年患者，男"*例，女$例；年龄%+,-+岁，平均)&岁；.""!"例，."&!-例，/"!$例，/&!*例，/+!+例。按照9:;<:骨质疏松分级标准，骨质疏松初期者)例，!级者*例，"级者"+例。所有病例均采用后路切开复位椎弓根系统短节段内固定术，应用>?钉-例，6?钉$例，@22=)例，2ABAC=-=例。行侧前方减压")例，未做任何减压"(例。术中采取增加螺钉直径、应用椎体复位器等措施，使塌陷的椎体复位，并增加椎弓根螺钉的固定强度；同时进行椎体内植骨，增加椎体愈合后的强度。结果术后随访#,%$个月，平均&$个月，骨折均达到满意复位并愈合，矢状位指数从伤前的平均)+D恢复至术后的$#E。未发生内置物断裂和螺钉松动现象，也无复位丢失现象。结论中老年人多存在不同程度的骨质疏松，对其脊柱胸腰段爆裂型骨折的治疗应采取相应措施，以降低手术的失败率。
Objective To discuss methods of pedicle screw fixation for thoracolumbar burst fractures among middle and old aged patients with different degree of osteoporosis, and to improve the clinical result by individualized treatment according to fracture characteristics. Methods There were totally 25 patients, 17 males, and 8 females. These patients with a mean age of 52 years (range, 43-63 years), had suffered from thoracolumbar burst fractures consisted of 1 T11 fracture, 6 T12 fractures, 8 L1 fractures, 7 L2 fractures, 3 L3 fractures. According to Jikeis osteoporosis grading system, 5 patients were of early stage, 7 of stage Ⅰ, 13 of stageⅡ. Posterior stabilization with the short-segment pedicle screw system were given to all the patients, among which 6 RF, 8 AF, 5 USS, 6 Socon were performed. Fifteen patients received anterolateral decompression, and ten patients accepted no decompression at all. Some measures were taken in order to enhance the fixation stiffness for pedicle screw system, such as increasing the screws diameter, using the vertebral body reducer to reduce the depressed vertebral body and so on. To enhance vertebral body strength after fracture union, transpedicular bone graft was also performed. Results All the patients achieved fracture union during the follow-up with a mean period of 28 months (range, 9-48 months). All of the fractures were reduced satisfactorily, SI (sagittal index) was improved from 53% to 89% after operation. No fracture of screws or rods occurred, also no screw loosened. No reduction loss was found. Conclusion In order to decrease failure rate of pedicle screw fixation for thoracolumbar fractures among middle and old aged patients, osteoporosis of vertebral body should never be neglected and, of course, treatment should be given with individualized fixation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第12期727-731,共5页
Chinese Journal of Orthopaedics
