摘要
目的分析下腰椎骨折的损伤特点,探讨改良胸腰椎损伤分类及损伤程度评分（thoracolumbar injury classification and severity score,TLICS）系统指导下腰椎骨折治疗的可行性。方法收集本院2008年1月~2012年12月收治的下腰椎骨折病例资料89例,按AO分型：A3.1型22例,A3.2型22例,A3.3型31例,B2.3型6例,C1.3型8例。用改良TLICS系统进行评分,根据评分结果确定治疗方案。对比术前、术后和末次随访时影像结果,观察植骨融合情况以及内固定是否存在弯曲、松动或断裂现象。采用Frankel分级标准评定脊髓神经功能恢复情况。结果本组手术病例切口无感染。随访12~60个月,平均29.2个月;未出现内固定松动或断裂现象。在Cobb角、椎体前缘高度压缩比及椎管占位恢复方面,术后与术前相比差异有统计学意义（P〈0.05）;术后与末次随访相比差异无统计学意义（P〉0.05）。82例患者植骨融合良好,脊髓神经功能有Ⅰ~Ⅱ级的恢复。结论由于下腰椎具有完全不同的损伤特点,应根据损伤类型和程度采用不同的手术方法,改良TLICS系统是指导下腰椎骨折治疗的较好方法。
Objective To investigate the characteristics of lower lumber vertebra fracture and the feasibility of applying modified thoracolumbar injury classification and severity score（ TLICS） system as a guideline for selecting treatment methods of lower lumbar vertebra fracture.Methods Eighty-nine patients of lower lumbar vertebra fracture,who received treatment between January 2008 and December 2012 were included in this study.According to the AO classification system,type-A3.1 injury occurred in 22 patients,type-A3.2 injury in 22 patients,type-A3.3 injury in 31 patients,type-B2.3 in 6 patients,and type-C1.3 in 8 patients.According to the injury characteristics of lower lumbar vertebra fracture,the modified TLICS system was used to guide treatment of lower lumbar vertebra fracture.Imaging data,bone graft fusion,internal fixation curving,loosening or breakage were observed after surgery as well as at the final follow-up.Neurological function recovery was assessed by the Frankel classification grading system.Results No wound infection or aggravated neurological deficit was observed in all patients.All patients were followed up for 12-60months（ mean 29.2 months）.During the period of follow up,no pedicle screw loosening and / or breakage was observed.The Cobb＇s angle of the lumbar vertebra,compression ratio of injured spinal anterior edge,and space-occupying lesion in the spinal canal after surgery were significantly superior to those before surgery（ P〈0.05）,and there were no significant differences in these index between after surgery and at the final follow-up（ P〉0.05）.After surgery,bone graft fusion were achieved in 82 patients,and neurological function were improved for gradeⅠor Ⅱ.Conclusion The lower lumbar vertebra fracture has its own injury characteristics and its treatment method should be selected according to the type and degree of injury.The modified TLICS system is a preferred method for determining the treatment method of lower lumbar vertebra fracture.
出处
《脊柱外科杂志》
2015年第5期294-298,共5页
Journal of Spinal Surgery
基金
浙江省嘉兴市科技计划项目(2010AY1056)
关键词
腰椎
脊柱骨折
内固定器
减压术
外科
骨移植
Lumbar vertebrae
Spinal fractures
Internal fixators
Decompression
Surgical
Bone transplantation
