摘要
[目的]探讨经肌间隙入路伤椎置钉联合短节段椎弓根钉复位固定治疗胸腰段椎体骨折的可行性及临床疗效。[方法]2009年2月~2014年5月经肌间隙入路伤椎置钉联合短节段椎弓根钉复位固定治疗无神经损伤表现的胸腰椎单节段骨折31例,男22例,女9例;年龄31~61岁,平均36.9岁;受伤至手术时间2 h^4 d,平均2d。依据Denis骨折分型:压缩型骨折18例,爆裂型骨折13例。骨折部位:T_(11)2例,T_(12)12例,L_113例,L_24例。应用视觉模拟评分法(visual analogue scale,VAS)及健康调查简表(the MOS item short-form health sutvey,SF-36)评估患者疼痛及生活质量改善的情况,通过影像学测量评估伤椎的高度丢失及脊柱后凸畸形的矫正情况。[结果]所有患者均获得随访,平均随访时间17.8个月(12~41个月)。内固定无松动、断裂。术前、术后3 d、术后1年时伤椎前缘高度比分别为(47.2±9.4)%、(96.7±9.3)%、(93.6±6.5)%;矢状面Cobb角分别为(39.31±2.56)°、(5.71±0.42)°、(5.81±0.71)°;差异具有统计学意义(P<0.05)。随访期间伤椎前缘高度及Cobb角无明显丢失,患者术前和术后1年随访时VAS评分分别为(9.76±0.24)分、(1.55±0.06)分,SF-36量表评分分别为(92.4±2.11)分、(118.01±2.01)分,差异有统计学意义(P<0.05)。影像学评估提示患者的脊柱伤椎高度丢失和后凸畸形得到较好的矫正。[结论]经椎旁肌间隙入路短节段结合伤椎固定,具有操作简单,置钉容易,手术时间短,出血少,同时复位良好,术后稳定可靠,是治疗胸腰段椎体骨折的有效方法。
[Objective]To evaluate the feasibility and efficacy of pedicle screw fixation at the fracture leve in treating thoracolumbar fractures. [Method]From January 2009 to May 2014,31 patients with single level thoracolumbar fracture without neurological symptoms were treated with pedicle screw fixation at the fracture leve through paraspinal approach. There were 22 males and 9 females,aged from 31 to 61 years old with a mean of 36. 9 years. The duration from injury to operation ranged from 2 h to 4 d with an average of 2 d. According to the Denis fracture classification,compression fractures happedned in 18 cases and burst fractures happened in 13 cases. The fracture was located at T11 in 2 case,T12 in 12 cases,L1 in 13 cases and L2 in 4 cases. We evaluated the improvement of pain symptoms and life quality using The Visual Analogue Scale（ VAS） and The MOS 36-Item Short-Form Health Survey（ SF-36）,and assessed the corrected status of vertebral height loss and kyphotic deformity by radiographic measurement. [Result]All patients were followed up for 12 to 41 months（ mean 17. 8 months）. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative,3 days and 1 year after operation were 47. 2 ± 9. 4,96. 7 ± 9.3,93. 6 ± 6. 5,respectively. Sagittal Cobb angle at the three time points were（ 39. 31 ± 2. 56） °,（ 5. 71 ± 0. 42） °,（ 5. 81 ± 0.71） °,respectively,all differences were statistically significant（ P 〈 0. 05）. The VAS score and the SF-36 score before operationboth improved at one year after operation follow- up,showing significant difference（ [9. 76 ± 0. 24]-[1. 55 ± 0. 06],P 〈0. 05） and（ [92. 4 ± 2. 11]-[118. 01 ± 2. 01]P 〈 0. 05）. Imaging evaluation showed well correction of the lost height of the injured vertebrae and kyphotic deformity. [Conclusion]The paraspinal approach combined with short segment pedicle screws fixation at the fracture level is an good way for treating thoracolumbar fractures. This method has advantages of simple
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第8期697-701,共5页
Orthopedic Journal of China
关键词
胸椎
腰椎
椎弓根螺钉
内固定
thoracic vertebrae
lumbar vertebrae
pedicle screw
internal fixation
