刘潮坚;蔡拉加;石昭宏;林剑雄;

• 1:广东省潮州市中心医院骨外科

摘要(Abstract)：

[目的]比较伤椎置钉与传统伤椎不置钉后路短节段固定治疗胸腰椎爆裂性骨折的临床疗效及影像学结果。[方法]2009年2月~2013年2月共70例患者纳入本研究,根据伤椎是否置钉将患者分为置钉组(采用短节段椎弓根螺钉固定伤椎上下椎体,联合伤椎置钉,33例)和不置钉组(采用短节段椎弓根螺钉固定伤椎上下椎体,而伤椎不置钉,37例)。比较两组患者手术时间、出血量(术中失血量+术后引流量)、住院天数、围手术期并发症、术后24个月时Oswestry功能障碍指数(ODI)、术后伤椎高度矫正率术后24个月伤椎高度矫正丢失率、术后Cobb角矫正率及术后24个月Cobb角矫正丢失率。[结果]两组患者手术时间、出血量、住院天数、术后并发症发生率、术后伤椎高度矫正率、术后Cobb角矫正率及术后24个月ODI等比较差异无统计学意义(P>0.05),但两组患者术后24个月伤椎高度矫正丢失率及术后24个月Cobb角矫正丢失率比较差异有统计学意义(P<0.05)。[结论]短节段椎弓根螺钉治疗胸腰椎爆裂性骨折,伤椎置钉与伤椎不置钉,临床疗效相似,但是伤椎置钉能够有效恢复并维持椎体高度、减少术后后凸畸形矫正丢失,是治疗胸腰椎爆裂性骨折的适宜选择。

关键词(KeyWords)： 胸腰椎骨折;骨折内固定;短节段椎弓根螺钉固定系统

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘潮坚;蔡拉加;石昭宏;林剑雄;

Email:

DOI:

参考文献(References)：

• [1]Cho DY,Lee WY,Sheu PC.Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation[J].Neurosurgery,2003,53(6):1354-1361.
• [2]史晓林,刘磊,张昊,等.伤椎单侧置钉植骨治疗Denis B型胸腰椎爆裂骨折的临床研究[J].实用骨科杂志,2015,21(3):243-246.
• [3]Mahar A,Kim C,Wedemeyer M,et al.Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture[J].Spine,2007,32(14):1503-1150.
• [4]Modi HN,Chung KJ,Seo IW,et al.Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology[J].J Orthop Surg Res,2009,4(1):28.
• [5]刘意强,韦国平.胸腰椎爆裂性骨折植骨技术的应用进展[J].中国矫形外科杂志,2014,22(4):337-340.
• [6]kten A,Gezercan Y,zsoy KM,et al.Results of treatment of unstable thoracolumbar burst fractures using pedicle instrumentation with and without fracture-level screws[J].Acta Neurochir Wien,2015,157(5):831-836.
• [7]叶生余,王宸.肌间隙入路与后正中入路治疗胸腰椎骨折比较[J].实用骨科杂志,2014,20(2):156-158.
• [8]盛雷,莫臣强.后路短节段与长节段椎弓根螺钉固定治疗胸腰椎爆裂性骨折疗效比较[J].海南医学,2015,7(6):819-821.
• [9]Payer M.Unstable burst fractures of the thoraco-lumbar junction:treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation[J].Acta Neurochir Wien,2005,148(3):299-306.
• [10]刘鸿,罗勇,粱轶,等.经后路短节段固定联合伤椎置钉治疗胸腰椎骨折临床疗效观察[J].吉林医学,2015,36(4):728-729.
• [11]Siebenga J,Leferink VJ,Segers MJ,et al.Treatment of traumatic thoracolumbar spine fractures:a multicenter prospective randomized study of operative versus nonsurgical treatment[J].Spine,2006,31(25):2881-2890.
• [12]Norton RP,Milne EL,Kaimrajh DN,et al.Biomechanical analysis of four-versus six-screw constructs for short-segment pedicle screw and rod instrumentation of unstable thoracolumbar fractures[J].Spine J,2014,14(8):1734-1739.
• [13]Grossbach AJ,Viljoen SV,Hitchon PW,et al.Vertebroplasty plus short segment pedicle screw fixation in a burst fracture model in cadaveric spines[J].J Clin Neurosci,2015,22(5):883-888.
• [14]常锐,王丰爱,王海霞,等.伤椎置短钉技术治疗胸腰椎爆裂骨折的疗效分析[J].中国矫形外科杂志,2014,22(8):683-686.
• [15]曾小军,赵宙.伤椎置钉和跨伤椎固定治疗胸腰椎相邻两椎体骨折的比较[J].实用骨科杂志,2013,19(7):579-583.
• [16]丁少成,曹家俊,魏学忠,等.后路长节段与短节段椎弓根螺钉固定治疗胸腰椎骨折的疗效比较[J].中国修复重建外科杂志,2013,27(6):690-695.
• [17]Guven O,Kocaoglu B,Bezer M,et al.The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J].J Spinal Disord Tech,2009,22(6):417-421.
• [18]柳超,王雷,田纪伟,等.椎弓根螺钉联合伤椎置钉治疗合并骨质疏松症的胸腰段爆裂骨折[J].中华医学杂志,2013,93(25):1993-1996.
• [19]Mc Namara MJ,Stephens GC,Spengler DM.Transpedicular short-segment fusions for treatment of lumbar burst fractures[J].J Spinal Disord,1992,5(2):183-187.