摘要
目的探讨经后路脊柱重建治疗老年Magerl B胸腰椎骨折的临床效果。方法选择2013年1月～2015年10月我院收治的老年Magerl B型胸腰椎骨折86例患者,所有患者均行经后路椎管探查减压,椎体内植骨椎弓根钉棒系统内固定术,手术前后行CT检查计算伤椎椎管狭窄率,根据X线片测量伤椎高度变化评估椎体高度恢复、用Cobb角变化评估后凸矫正情况,Frankel分级标准变化评估神经功能恢复情况及干预后不同时间点腰背部疼痛视觉模拟(VAS)评分变化情况。结果 86例患者经24～32个月随访,术后1周、1、2年CT检查提示伤椎骨折愈合,植骨满意,无断钉断棒。术前、术后1周、术后1和2年后椎管狭窄率、伤椎相对高度比、Cobb角较术前均显著改善(P<0.05),干预后1周、干预后1及2年后,腰背部疼痛VAS评分均低于干预前(P<0.05)。结论对Magerl B型胸腰椎骨折可单纯经后路固定、前柱结构重建并椎管减压,为该类型的胸腰椎骨折提供了一个相对微创、安全、效果可靠的手术方式。
Objective To investigate the clinical effect of posterior spinal reconstruction in the treatment of Magerl B thoracolumbar fractures of the elderly.Methods Altogether 86 cases elderly patients with Magerl type B thoracolumbar fractures from January 2013 to October 2015 were selected.All patients underwent posterior spinal canal decompression,and the vertebral body was implanted in the pedicle screw system.Then fixation,preoperative and postoperative CT examinations were performed,and the rate of vertebral canal stenosis,vertebral body height recovery were calculated and evaluated,and changes in height of the vertebral injury measured by X-ray film,and kyphosis correction were assessed by Cobb angle change.Frankel grading standard changes were used to evaluate nerve function.Recovery status and changes in visual analogue scale(VAS)scores of low back pain at different time points after intervention.Results A total of 86 patients were followed up for 24-32 months.CT examinations at 1 week,1 year,and 2 years after surgery showed that the fractures of the injured vertebrae healed,the bone graft were satisfactory and no broken nails were broken.The rate of spinal canal stenosis before surgery,1 week after surgery,1 year after surgery,and 2 years,the postoperative spinal stenosis rate,the relative height ratio of injured vertebrae and the Cobb angle were improved(P<0.05).One week after intervention,one year after the intervention,and two years after the intervention,the VAS scores of low back pain were lower than those before intervention(P<0.05).Conclusion For Magerl B thoracolumbar fractures,posterior fixation,anterior column structure reconstruction and spinal canal decompression can be performed.This provides a relatively minimally invasive,safe and reliable surgical approach for this type of thoracolumbar fracture.
作者
付聪聪
FU Cong-cong(Department of Orthopedics and Traumatology,Qingdao Integrated Traditional Chinese and Western Medicine Hospital,Shandong Province,Qingdao266002,China)
出处
《中国当代医药》
2018年第34期114-117,共4页
China Modern Medicine
