摘要
目的探讨椎弓根螺钉联合经椎板螺钉(TLS)治疗胸腰椎骨折的价值.方法6具腰椎标本,模拟三柱不稳定骨折模型,以椎弓根螺钉固定(CD)或椎弓根螺钉联合经TLS固定(CD+TLS),测量脊柱运动范围(ROM),比较两种方法的稳定性.31例胸腰椎骨折椎体前缘平均压缩至59%,椎体后缘压缩至88%,采用椎弓根螺钉联合TLS治疗,20例同时行后路或前后路植骨.结果'CD+TLS'组较CD组前屈、侧弯和轴向旋转分别减少5.38%、4.91%和11.85%,两种方法间ROM经t检验,除后伸压缩外,差异均有显著性意义(P＜0.05).术后椎体前缘恢复到97%,椎体后缘恢复到98%,随访4～34个月,平均13个月,椎体前缘矫正丢失5.0%,其中植骨组20例均融合,平均融合时间4.3个月,矫正丢失3.8%.结论TLS联合椎弓根螺钉治疗胸腰椎骨折,增加了固定器稳定性,TLS主要起抗旋转和抗后柱分离作用,可以提高后路植骨融合率,减少矫正丢失.
Objective To probe the value of pedicle scr ew s with translaminar screws (abbreviated TLS) in the treatment of thoracolumbar f ractures.Methods Six lumbar specimens were used to simulate three_colume instability of spine.Th e specimens were fixed with pedicle screws (CD) or pedicle screws with TLS (CD +TLS).Range of motion (ROM) of spine was measured to compare stability of the two fixation methods. Pedicle screws with TLS were clinically applied in the treatment of 31 cases of thoracolumbar fractures.The posterior or posterior_anterior bone graft was per formed in 20 of them.The anterior and posterior height of vertebra bodies were compress ed to 59% and 88% respectively before operation. Results The ROM were decreased by 5.38%,4.91% and 11.85% in flexion,lateral bendin g and rotation respectively in “CD+TLS” group,and were significant different with CD group(P<0.05).The anterior and posterior height of vertebra body were restored to 97% and 98% normal height in 31 cases.The 4～34 months of follow_up,averaged 13 months,revealed 5.0% loss of correction.The solid fusion achieved in all 20 cases of bone graft,wit hin averaged 4.3 months,and the loss of correction was 3.8%. Conclusion Pedicle screws with TLS help increase the stability of pedicle screws in the tre atment of thoracolumbar fractures,mainly by preventing the rotation and distrac tion of posterior column.It increases the posterior fusion rate of spine and re duce the loss of correction.
出处
《中国骨与关节损伤杂志》
2005年第6期379-381,共3页
Chinese Journal of Bone and Joint Injury
基金
江苏省中医药管理局科研课题(编号:JSGJ2003-02-10)
