摘要
目的评估椎弓根固定治疗不稳定胸腰椎骨折的临床疗效和安全性。方法1998～2001年,我们对31例T11～L2不稳定胸腰椎骨折患者,行椎弓根固定和横突间植骨治疗,其中男24例,女7例,平均年龄38岁。有或无神经症状的不稳定压缩骨折21例,爆裂性骨折伴不完全截瘫6例,爆裂性骨折伴完全截瘫4例。术前和术后均行X片和CT检查。术后通过平均2年的临床和放射学随访,观察脊柱的稳定性和植骨融合的情况。CT和X片评估标准包括脊柱后突角度、椎体前缘高度的压缩比例和椎管内占位的比例。结果所有椎弓根螺钉在术中的植入过程中都没有出现并发症。术后无1例患者出现内固定的失败或因疼痛原因需要行内固定取出,术后平均4个月出现骨折的愈合和放射学的稳定性。术前平均脊柱后突角度、椎体前缘高度的压缩比例、椎管内占位的比例分别为25°,42%,37%,术后1周平均为9°,10%、13%,术后2年平均为11°,13%、11%。结论后路椎弓根固定是治疗不稳定胸腰椎骨折的一种安全和有效的方法。即使在缺乏后方脊柱完整性的情况下,它仍能提供早期坚强固定,从而维持良好的三柱稳定性。
Objective To evaluate the efficacy and safety of the managem ent of unstable thoracolumbar fractures with pedicle screw fixation. Methods Fr om 1998 to 2001, 31 patients with unstable thoracolumbar fracture (T11-L2) were treated with pedicle screw fixation and transverse process bone fusion in our h ospital. There were 24 men and 7 women with an average age of 38 years old, of w hich 21 were unstable compression fractures with and without neurologic deficits , 6 burst fractures with incomplete paraplegia and 4 burst fractures with comple te paraplegia. Radiographs and computed tomography scans were done preoperativel y and postoperatively. The spinal stabilization and bone fusion were reviewed by clinical and radiographic follow-ups (averaging 2 years) postoperatively. CT a nd radiographic measurements involved kyphosis angle, percentage of anterior bod y height compression, and percentage of canal retropulsion. Results All the pedi cle screws were successfully placed without intraoperative complications. There were no reported cases of hardware failure or painful hardware removal. Fracture healing and radiographic stabilization occurred at an average of 4 months after the initial operation. Before surgery, the mean kyphosis angle, percentage of t he anterior body height compression and percentage of canal retropulsion were 25 °, 42%, 37% respectively whereas they were 9°, 10%, 13% a week after ope ration and 11°, 13%, 11% at the 2-year follow-up. Conclusion Pedicle screw fixation is a safe and effective alternative in the treatment of unstable thora columbar fractures, for even in the absence of posterior element integrity, it m ay still provide early rigid fixation and offer superior three-column stability .
出处
《中华创伤骨科杂志》
CAS
CSCD
2003年第4期335-337,共3页
Chinese Journal of Orthopaedic Trauma
