摘要
目的 探讨经椎弓根椎体内植骨椎弓根钉复位固定治疗胸腰椎骨折的方法和效果。方法 对 5 8例胸腰椎骨折在椎弓根钉复位固定的同时 ,用自制植骨推注器经椎弓根椎体内植骨结合中后路植骨治疗 ,术后卧床 2～ 3周 ,腰背肌锻炼、腰围固定。结果 本组随访 2个月～ 2年 3个月 ,优良率达 81% ,全部患者均在术后 2～ 3周活动 ,无断钉、断杆、松动、椎体再压缩等并发症。评价有两个方面 :①影像学评价 :包括椎体高度的恢复 ,椎管侵占率的恢复 ,脊柱矢状面的Cobb角。 4 7例患者椎体骨折基本达到解剖复位 ,远期复查椎体高度无丢失情况。②神经功能和临床评价 :4 1例合并神经损伤的病人Franke评级平均提高 1 5 1级 ,脊柱无明显畸行 ,无严重腰痛和下肢疼。结论 RF、AF、SF椎弓根系统对胸腰椎骨折具有良好的复位和固定作用 ,经椎弓根椎体内植骨在后路手术不加大创伤的同时 ,能即时增加椎体的骨容量和脊柱前柱的抗压稳定性 ,使病人能早期活动 ,减少内固定物因应力过大造成的断钉、断杆 ,椎体再压缩等并发症。
Objective To approach the method and effect for treatment of thoracolumbar vertebrae with the method of pedicle screw fixator and bone graft of vertebral body via pedicle.Methods Fifty eight cases of thoracolumbar vertebral fractures were used with self made injector into the lumbar vertebrae by process of transplantation of bones. After two or three weeks of operation, the patient performed some muscular activities in the back with the waist wrapper fixed.Results In the following visit, 58 cases had gained excellent and good results (81%) after two months to two years and three months.In two or three weeks after operation, all the patients could move about, without breaking of nails and shafts, loosing and other complications. We had two evalutations:①Fluoroscopy: recovery of the height of lumbar vertebrae, the invasion of the tube and the Cobb angle of the spinal surface.②Neuropathic function and clinical evalutation:41 cases of nerve injury had raised their Franke grade by 1 51. No apparent deformation of the spine or the pain in the waists and legs.Conclusion RF, AF, and SF pedicle fixators can restore and fix the thoracolumbar spinal fractures, and can increase the stability of the spine without injury after operation. It can enable the patients to move about as early as possible, and reduce the possibility of breaking of nails and shafts and other complications.
出处
《骨与关节损伤杂志》
2003年第2期76-78,共3页
The Journal of Bone and Joint Injury
