單純微創椎弓根釘內固定技術治療胸腰椎爆裂骨折的中期療效研究_《華西醫學》

作者：

吳亞鵬 ,  張瓊 , 王達義 , 溫國宏 , 常巍

湖北醫藥學院附屬太和醫院脊柱外科（湖北十堰，442000）;

關鍵詞：

脊柱骨折椎弓根釘微創內固定

DOI：

CNKI: 51-1356/R.20120115.1541.008

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價微創椎弓根釘內固定技術治療胸腰椎爆裂骨折的中期臨床療效。方法　2002年9月－2007年9月，采用微創椎弓根釘內固定技術治療胸腰椎爆裂骨折30例。其中男16例，女14例;年齡18～65歲，平均39.8歲。骨折節段:胸11者3例，胸12者13例，腰1者12例，腰者22例。所有骨折按AO分型，均為A3型。受傷至手術時間6 h～6 d，平均45 h。分析術后影像學指標、疼痛評分及功能障礙指數。結果　患者均獲隨訪，隨訪時間3～9年，平均5.2年。術后各時間點傷椎前緣高度及后凸Cobb角均較術前明顯恢復（P＜0.01）。術后傷椎高度隨隨訪時間延長逐漸下降，后凸Cobb角逐漸增大。取出內固定物后、術后2年、末次隨訪時動力位X線片上骨折椎體前后相對滑移距離分別為（1.9 ± 0.3）、（2.1 ± 0.2）、（2.1 ± 0.3）mm，兩兩比較差異無統計學意義（P＞0.05）。術后1、2年及末次隨訪時疼痛視覺模擬評分分別為（2.5 ± 1.2）、（2.5 ± 1.1）、（2.4 ± 1.3）分，兩兩比較差異無統計學意義（P＞0.05）。末次隨訪時Denis腰痛分級：P1級13例，P2級12例，P3級5例。功能障礙指數為（11.4 ± 3.1）分，獲優23例、良5例、可2例。結論　單純微創椎弓根釘內固定技術治療胸腰椎爆裂骨折中期臨床效果滿意，脊柱穩定性良好。
Objective　 To mid-term efficacy of the technique of minimally invasive pedicle screw fixation on thoracolumbar burst fracture. Methods　 From September 2002 to September 2007, 30 patients were treated with minimally invasive pedicle screw fixation for thoracolumbar fracture. There were 16 males and 14 females with the mean age of 39.8 years (range,18-65 years). The injured level of was T11 in 3 cases, T12 in 13 cases, L1 in 12 cases, and L2 in 2 cases. The type of thoracolumbar fractures of all the patients was A3 according to AO classification. The during from injury to operation was 6 hours to 6 days with an average of 45 hours. The index of image and pain and disability index were evaluated after operation. Results　 All patients were followed up for 3 to 9 years with the mean of 5.2 years. Their average sliding distance after operation for removing internal fixation was (1.9 ± 0.3), and (2.1 ± 0.2) mm 2 years after the operation and (2.1 ± 0.3) mm at the latest follow-up. There was no significant difference (P＞0.05). Their average score was (2.51 ± 1.2) 1 year after the operation, was (2.42 ± 1.1) 2 year after the operation, and was (2.36 ± 1.3) at the latest follow-up (P＞0.05). According to Denis score system to evaluate index of lumbago, there was P1 in 13 cases, P2 in 12 cases, and P3 in 5 cases. The score of Oswestry Disability Index (ODI) was 11.4 ± 3.1 at the latest follow-up. Twenty-one cases gotexcellent therapeutic result, five cases got good and two were moderate. Conclusions　 Minimally invasive pedicle screw fixation for the treatment of thoracolumbar burst fracture provide satisfactory clinical results. The vertebral body and adjacent vertebral body have a good stability.

引用本文： 吳亞鵬,張瓊,王達義,溫國宏,常巍. 單純微創椎弓根釘內固定技術治療胸腰椎爆裂骨折的中期療效研究. 華西醫學, 2012, 27(1): 33-36. doi: CNKI: 51-1356/R.20120115.1541.008 復制

1.	孫濤, 西永明, 汪貫習, 等. 椎間盤鏡下微創治療胸腰椎骨折[J]. 中國矯形外科雜志, 2005, 13(8): 634-635.
2.	吳亞鵬, 王達義, 常巍, 等. 微創內鏡下椎弓根釘固定治療無神經損傷胸腰椎骨折[J]. 實用骨科雜志, 2010, 16(7): 520-522.
3.	池永龍, 徐華梓, 林焱, 等. 微創經皮穿刺椎弓根螺釘內固定治療胸腰椎骨折的初步探討[J]. 中華外科雜志, 2004, 42(21): 1307-1311.
4.	Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders[J]. J Bone Joint Surg(Am), 2000, 82(10): 1458-1476.
5.	侯樹勛. 合理應用脊柱內固定減少術后并發癥[J]. 中華骨科雜志, 2003, 23(11): 643.
6.	楊雷, 李家順, 賈連順, 等. 經皮椎弓根螺釘技術的解剖學基礎及其臨床意義[J]. 中國臨床解剖學雜志, 2004, 22(1): 58-62.
7.	Kim DY, Lee SH, Chung SK, et al. Comparision of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J]. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
8.	王自立, 陳軍, 喬永東. 胸腰段脊柱骨折后路術后遲發后凸畸形的研究[J]. 中華創傷骨科雜志, 2005, 7(12): 1143-1146.
9.	翁習生, 徐宏光. 胸腰椎骨折整復內固定后是否應植骨融合[J]. 中國脊柱脊髓雜志雜志, 2002, 12(5): 328-329.
10.	Bono CM, Lee CK. Critical analysis of trends in fusion for degenerstive disk disease over the past 20 years: influence of technique on fusion rate and clinical outcome[J]. Spine (Phila Pa 1976), 2004, 29(4): 455-463.
11.	Leferink VJ, Zimmerman KW, Veldhuis EF, et al. Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients[J]. Eur Spine J, 2001, 10(6): 517-523.
12.	De’Boeck H, Opdecam P. Split coronal fractures of the lumbar spine. Treatment by posterior internal fixation and transpedicular bone grafting[J]. Int Orthop, 1999, 23(2): 87-90.
13.	Alanay A, Acaroglu E, Yazici M, et al. The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burstfractures on canal remodeling[J]. Eur Spine J, 2001, 10(6):.
14.	侯樹勛. 脊柱骨折治療中應注意的幾個問題[J]. 中華創傷雜志, 2005, 21(1): 60-62.
15.	-516.

1. 　孫濤, 西永明, 汪貫習, 等. 椎間盤鏡下微創治療胸腰椎骨折[J]. 中國矯形外科雜志, 2005, 13(8): 634-635.
2. 　吳亞鵬, 王達義, 常巍, 等. 微創內鏡下椎弓根釘固定治療無神經損傷胸腰椎骨折[J]. 實用骨科雜志, 2010, 16(7): 520-522.
3. 　池永龍, 徐華梓, 林焱, 等. 微創經皮穿刺椎弓根螺釘內固定治療胸腰椎骨折的初步探討[J]. 中華外科雜志, 2004, 42(21): 1307-1311.
4. 　Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders[J]. J Bone Joint Surg(Am), 2000, 82(10): 1458-1476.
5. 　侯樹勛. 合理應用脊柱內固定減少術后并發癥[J]. 中華骨科雜志, 2003, 23(11): 643.
6. 　楊雷, 李家順, 賈連順, 等. 經皮椎弓根螺釘技術的解剖學基礎及其臨床意義[J]. 中國臨床解剖學雜志, 2004, 22(1): 58-62.
7. 　Kim DY, Lee SH, Chung SK, et al. Comparision of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J]. Spine (Phila Pa 1976), 2005, 30(1): 123-129.
8. 　王自立, 陳軍, 喬永東. 胸腰段脊柱骨折后路術后遲發后凸畸形的研究[J]. 中華創傷骨科雜志, 2005, 7(12): 1143-1146.
9. 　翁習生, 徐宏光. 胸腰椎骨折整復內固定后是否應植骨融合[J]. 中國脊柱脊髓雜志雜志, 2002, 12(5): 328-329.
10. 　Bono CM, Lee CK. Critical analysis of trends in fusion for degenerstive disk disease over the past 20 years: influence of technique on fusion rate and clinical outcome[J]. Spine (Phila Pa 1976), 2004, 29(4): 455-463.
11. 　Leferink VJ, Zimmerman KW, Veldhuis EF, et al. Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients[J]. Eur Spine J, 2001, 10(6): 517-523.
12. 　De’Boeck H, Opdecam P. Split coronal fractures of the lumbar spine. Treatment by posterior internal fixation and transpedicular bone grafting[J]. Int Orthop, 1999, 23(2): 87-90.
13. 　Alanay A, Acaroglu E, Yazici M, et al. The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burstfractures on canal remodeling[J]. Eur Spine J, 2001, 10(6):.
14. 　侯樹勛. 脊柱骨折治療中應注意的幾個問題[J]. 中華創傷雜志, 2005, 21(1): 60-62.
15. -516.

《華西醫學》

單純微創椎弓根釘內固定技術治療胸腰椎爆裂骨折的中期療效研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《華西醫學》

單純微創椎弓根釘內固定技術治療胸腰椎爆裂骨折的中期療效研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料