摘要
目的对近年采取经单侧椎管撬拨复位椎体内植骨椎弓根螺钉固定术的165例DENIS分型中A、B两型的术后疗效和影像学进行评估。方法对2009年7月-2012年3月收治的165例胸腰椎骨折患者行单侧椎管撬拨复位椎体内植骨椎弓根螺钉固定术治疗，其中男131例，女34例，平均年龄34．61岁，165例中有128为单一椎体损伤，37例为邻椎或跳跃邻近椎体损伤。术前VAS疼痛评分平均6．8分，伤椎前缘高度平均（41．54±8．73）％，椎中部高度（51．63±8．75）％，脊柱后凸角（Cobb角）（27．31±8．24）°，椎管正中矢状径（63．30±9．65）％，神经功能按Frankel分级：A级13例，B级19例，C级22例，D级25例，E级86例。术前均作X片、螺旋CT并三维图像重组检查，伴有脊髓神经损伤者加做MRI，伤后2周内手术。术后复查X片，73例患者复查螺旋CT并进行三维图像重组检查。结果随访6-25个月，平均9．5个月，评价术前、后椎体前缘、椎体中部高度及椎管横截面恢复情况，并进行三维图像重组评价突入椎管骨块复位、植骨分布及愈合情况。术后VAS疼痛评分平均1．6分，末次随访术后X片：平均伤椎前缘恢复至伤前的（96．72±5．58）％，椎体中部高度恢复至（92．55±8．03）％。脊柱后凸角（Cobb角）为（4．57±1．37）°，椎管正中矢状径恢复到（94．25±6．32）％，突入椎管的骨块对硬膜囊和神经根无明显卡压。CT见夯填植骨分布较广泛、均匀。手术前后对比差异有显著性（P〈0．01）。术后神经功能恢复情况：A级7例，B级11例，c级19例，D级22例，E级106例。术后并发症；9例切口渗液时间较长，均一期愈合，无切口感染，2例发生内固定断裂，其余内固定无明显松动，末次随访矫正丢失（1．37±0．56）°，与术后比较无明显差异（P〉0．05）等。结论经单侧椎管撬拨复位椎体内植骨椎弓根螺钉固定术方法能让胸腰椎骨折获得满意复位，可有效重建椎体高度，增强伤椎的瞬时稳定性，可有效减少内固定因应力过大造成的断钉、矫正丢失等并发症，是一种解决椎体骨折复位后蛋壳效应的有效途径。
[Objective] To evaluate the efficacy and imaging of 165 cases of types A, B fractures in unilateral vertebral canal reduction by prying and bone grafting in injured vertebral body and pedicle screws fixation after op- eration. [Methods] From July 2009 to March 2012, 165 patients with thoraeolumbar fractures of Denis A, B type were treated with unilateral reduction by pryinge and bone grafting trans vertebral canal and segment pediele screws fixation. There were 131 males and 34 females with an average age of 34.61 years （range, 17-66 years）. In all 165 cases, 128 for a single vertebral body damage, 37 cases of neighbors vertebral or jumping adjacent vertebral bodydamage. Preoperative VAS pain score averaged 6.8 points. The preoperative anterior border height percentage of in- jured vertebra was （41.54±8.73）%, central vertebral height was （51.63±8.75）%, the spine of the protruding after An- gle （Cobb Angle） was （27.31±8.24）°, the center of the vertebral canal sagittal diameter （63.30±9.65）%. According to Frankel grades of injury spinal cord and cauda equina, there were grade A 13 cases, grade B 19 cases, grade C 22eases, grade D 25 cases and grade E 86 cases. Preoperative X-ray and spiral CT and 3 d image restructuring, associated with spinal cord injuries with magnetic resonance imaging （MRI）. All patients were in two weeks of surgery after injury.postoperative X-ray was reviewed, 53 cases of patients with spiral CT and 3 D image restruc- turing, were followed up for 6 to 25 months, an average of 9.5 months, preoperative evaluation, after the anterior border height, central vertebral height of injury vertebral body and spinal canal cross section recovery, and 3 d im- age restructuring evaluation into vertebral canal bone restoration, distribution, and healing of bone graft. [ Results ] Postoperative complications： 9 cases of incision drainage for a long time, were primary healing, no incision infection, 2 cases of internal fixation of breakage, the fixation without apparent looseness in other cases, the last follow-up cor- rection loss of （1.37±0.56）°, and there was no significant difference in comparison （P 〉0.05）. Postoperative neurolog- ie recovery： class A 7 cases, class B 11 cases, class C 19 cases, class D 22 cases and class E 106 cases.Postopera- tive VAS pain score averaged 1.6 points. X-ray films of 165 cases of postoperative patients with last follow-up, an- terior border height percentage of injury vertebra to （96.72±5.58）%, central vertebral height restoration to （92.55± 8.03）%. The Cobb Angle decreased to （4.57±1.37）°, the center of the vertebral canal sagittal diameter to （94.25± 6.32）%, into vertebral canal bone block of no compression of dural sac and nerve root. Filling bone graft was widely distributed and uniform. Before and after surgery compared significant difference （P 〈0.05）. [ Conclusion ] The uni- lateral vertebral canal prying reduction and vertebral body bone graft and pedicle screw fixation can lead a thora- columbar fracture satisfactory restoration method, which can effectively restore vertebral body height, enhance the transient stability of the vertebral injury. It can reduce effectively the occurrence of screws breakage of internal fixa- tion and corrective loss and other complications. This operation method is a kind of effective solution to egg-shell effect after reduction of verterbral body fracture.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第22期47-52,共6页
China Journal of Modern Medicine
基金
贵州省科技厅科学技术基金课题(No:黔科合J字[2010]2179号)
遵义医学院博士启动基金课题(No:遵医院办发[2010]19号)
关键词
胸腰椎骨折
椎管
植骨术
椎弓根螺钉
影像学
throacolumbar fracture
grafting
spinal canal
pedicle screws
imageology
