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【摘要】 目的:探讨单运动单元内固定治疗胸腰椎骨折的可行性、安全性和疗效。方法:通过前瞻性研究方法,选取本院38例胸腰椎骨折患者行单运动单元内固定治疗。骨折按Denis分型:A型17例,B型19例,C型2例。按ASIA分级评定术前术后脊髓神经功能。测量并比较术前、术后1周、3个月、12个月的Cobb角。结果:38例均得到随访。术后脊髓神经功能较术前明显改善,差异有统计学意义(P<0.05)。Cobb角:术后1周平均(3.8±1.7)°;术后3个月平均(3.9±1.9)°;术后12个月平均(3.9±2.1)°。术前与术后Cobb角比较差异均有统计学意义(P<0.05);术后各时段Cobb角比较差异无统计学意义(P>0.05)。结论:单运动单元内固定可用于治疗部分胸腰椎骨折。
【关键词】 胸椎; 腰椎; 脊柱骨折; 骨折固定术
【Abstract】 Objective:To investigate the feasibility,safety and therapeutic effects of monosegment pedicle instrumentation for the treatment of thoracolumbar fracture.Method:38 patients with thoracolumbar fracture were enrolled in this prospective study,all patients were treated with monosegment pedicle internal fixation.According to Denis classification,17 patients were type A,19 cases of tybe B and 2 cases of tybe C.ASIA were used to evaluate spinal cord function.Cobb angle were measured and compared at preoperatively,one week postoperatively,three months postoperatively,twelve months postoperatively.Result:All patients were followed up successfully.The postoperative ASIA grades were significantly better than the preoperative(P<0.05).The average Cobb angle at one week postoperatively was (3.8±1.7)°,which was (3.9±1.9)° at three months postoperatively and (3.9±2.1)° at twelve months postoperatively,the differences were statistically significant in the Cobb angle between preoperatively and postoperatively(P<0.05),but there were no statistically significant differences in the Cobb angle at each period postoperatively(P>0.05).Conclusion:Monosegment pedicle internal fixation can be used in part of thoracolumbar fracture.
【Key words】 Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Fracture fixation
First-author’s address:The Second People’s Hospital of Yibin City,Yibin 644300,China
doi:10.3969/j.issn.1674-4985.2016.05.035
胸腰椎骨折是一种常见的脊柱创伤,约占脊柱骨折的50%。目前对胸腰椎骨折的治疗仍以手术治疗为主,后路椎弓根螺钉固定是主要的手术方式之一。经典的后路椎弓根螺钉固定方式是双运动单元固定,即三节段跨伤椎固定,又称为短节段椎弓根螺钉固定,但存在手术创伤较大、多融合一个节段等缺点。近年来,有学者为解决上述问题提出单运动单元固定(monosegmental pedicle instrumentation,MSPI)[1-3],即伤椎双椎固定。2008年10月-2014年6月,笔者应用单运动单元固定治疗胸腰椎骨折并获得完整随访资料的病例共38例,取得了满意的疗效,现报道如下。
1 资料与方法
1.1 一般资料 纳入标准:(1)年龄范围为18~50岁;(2)骨折椎体为单一椎体,骨折类型按Denis分型为A型、B型和C型;(3)双侧椎弓根完好;(4)一侧终板骨折;(5)椎体前缘高度压缩<50%;(6)脊髓神经功能按ASIA分级为Ⅴ级和单侧Ⅳ级。排除标准:(1)相邻一个以上的椎体骨折;(2)椎弓根有骨折、不完整;(3)上下终板均有骨折;(4)病理性骨折;(5)双侧有神经损伤表现者。选取2008年10月-2014年6月本院收治的38例胸腰椎骨折患者,其中男32例,女6例;年龄19~50岁,平均(39.6±10.7)岁;跌坠伤22例,车祸伤13例,砸压伤3例。骨折部位:T114例,T1211例,L119例,L23例,L31例。骨折按Denis分型:A型17例,B型19例,C型2例。脊髓神经功能按ASIA分级:Ⅳ级9例,Ⅴ级29例。Cobb角:5°~19°,平均(13.7±8.6)°。伤后至手术时间3~6 d,平均(4.1±1.8)d。 [18] Cheh G,Bridwell K H,Lenke L G,et al.Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation:a minimum 5-year follow-up[J].Spine(Phila Pa 1976),2007,32(20):2253-2257.
[19]王涛.早期手术治疗胸腰椎爆裂性骨折的临床研究[J].中国医学创新,2010,7(24):62-63.
[20]王兴水.胸腰椎骨折内固定方法应用的比较分析[J].中国医学创新,2013,10(13):43-44.
[21] Hirano T,Hasegawa K,Takahashi H E,et al.Structural characteristics of the pedicle and its role in screw stability[J].Spine(Phila Pa 1976),1997,22(21):2504-2510.
[22]魏富鑫,刘少喻,赵卫东,等.单节段与双节段椎弓根螺钉固定胸腰椎单椎体骨折的生物力学比较[J].中国脊柱脊髓杂志,2007,17(1):46-50.
[23] Anekstein Y,Brosh T,Mirovsky Y.Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study[J].J Spinal Disord Tech,2007,20(10):72-77.
[24]海涌,鲁世保,王庆一,等.单节段伤椎椎弓根螺钉内固定治疗胸腰段骨折[J].首都医科大学学报,2008,29(6):686-689.
[25]李熙雷,周晓岗,董健,等.单节段与短节段椎弓根螺钉固定治疗胸腰椎爆裂性骨折[J].中华外科杂志,2011,49(4):315-319.
[26]庄青山,徐兆万,王炳武,等.终板法置钉单运动元固定治疗胸腰椎骨折[J].中国脊柱脊髓杂志,2008,18(10):730-734.
(收稿日期:2015-07-13) (本文编辑:欧丽)
【关键词】 胸椎; 腰椎; 脊柱骨折; 骨折固定术
【Abstract】 Objective:To investigate the feasibility,safety and therapeutic effects of monosegment pedicle instrumentation for the treatment of thoracolumbar fracture.Method:38 patients with thoracolumbar fracture were enrolled in this prospective study,all patients were treated with monosegment pedicle internal fixation.According to Denis classification,17 patients were type A,19 cases of tybe B and 2 cases of tybe C.ASIA were used to evaluate spinal cord function.Cobb angle were measured and compared at preoperatively,one week postoperatively,three months postoperatively,twelve months postoperatively.Result:All patients were followed up successfully.The postoperative ASIA grades were significantly better than the preoperative(P<0.05).The average Cobb angle at one week postoperatively was (3.8±1.7)°,which was (3.9±1.9)° at three months postoperatively and (3.9±2.1)° at twelve months postoperatively,the differences were statistically significant in the Cobb angle between preoperatively and postoperatively(P<0.05),but there were no statistically significant differences in the Cobb angle at each period postoperatively(P>0.05).Conclusion:Monosegment pedicle internal fixation can be used in part of thoracolumbar fracture.
【Key words】 Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Fracture fixation
First-author’s address:The Second People’s Hospital of Yibin City,Yibin 644300,China
doi:10.3969/j.issn.1674-4985.2016.05.035
胸腰椎骨折是一种常见的脊柱创伤,约占脊柱骨折的50%。目前对胸腰椎骨折的治疗仍以手术治疗为主,后路椎弓根螺钉固定是主要的手术方式之一。经典的后路椎弓根螺钉固定方式是双运动单元固定,即三节段跨伤椎固定,又称为短节段椎弓根螺钉固定,但存在手术创伤较大、多融合一个节段等缺点。近年来,有学者为解决上述问题提出单运动单元固定(monosegmental pedicle instrumentation,MSPI)[1-3],即伤椎双椎固定。2008年10月-2014年6月,笔者应用单运动单元固定治疗胸腰椎骨折并获得完整随访资料的病例共38例,取得了满意的疗效,现报道如下。
1 资料与方法
1.1 一般资料 纳入标准:(1)年龄范围为18~50岁;(2)骨折椎体为单一椎体,骨折类型按Denis分型为A型、B型和C型;(3)双侧椎弓根完好;(4)一侧终板骨折;(5)椎体前缘高度压缩<50%;(6)脊髓神经功能按ASIA分级为Ⅴ级和单侧Ⅳ级。排除标准:(1)相邻一个以上的椎体骨折;(2)椎弓根有骨折、不完整;(3)上下终板均有骨折;(4)病理性骨折;(5)双侧有神经损伤表现者。选取2008年10月-2014年6月本院收治的38例胸腰椎骨折患者,其中男32例,女6例;年龄19~50岁,平均(39.6±10.7)岁;跌坠伤22例,车祸伤13例,砸压伤3例。骨折部位:T114例,T1211例,L119例,L23例,L31例。骨折按Denis分型:A型17例,B型19例,C型2例。脊髓神经功能按ASIA分级:Ⅳ级9例,Ⅴ级29例。Cobb角:5°~19°,平均(13.7±8.6)°。伤后至手术时间3~6 d,平均(4.1±1.8)d。 [18] Cheh G,Bridwell K H,Lenke L G,et al.Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation:a minimum 5-year follow-up[J].Spine(Phila Pa 1976),2007,32(20):2253-2257.
[19]王涛.早期手术治疗胸腰椎爆裂性骨折的临床研究[J].中国医学创新,2010,7(24):62-63.
[20]王兴水.胸腰椎骨折内固定方法应用的比较分析[J].中国医学创新,2013,10(13):43-44.
[21] Hirano T,Hasegawa K,Takahashi H E,et al.Structural characteristics of the pedicle and its role in screw stability[J].Spine(Phila Pa 1976),1997,22(21):2504-2510.
[22]魏富鑫,刘少喻,赵卫东,等.单节段与双节段椎弓根螺钉固定胸腰椎单椎体骨折的生物力学比较[J].中国脊柱脊髓杂志,2007,17(1):46-50.
[23] Anekstein Y,Brosh T,Mirovsky Y.Intermediate screws in short segment pedicular fixation for thoracic and lumbar fractures:a biomechanical study[J].J Spinal Disord Tech,2007,20(10):72-77.
[24]海涌,鲁世保,王庆一,等.单节段伤椎椎弓根螺钉内固定治疗胸腰段骨折[J].首都医科大学学报,2008,29(6):686-689.
[25]李熙雷,周晓岗,董健,等.单节段与短节段椎弓根螺钉固定治疗胸腰椎爆裂性骨折[J].中华外科杂志,2011,49(4):315-319.
[26]庄青山,徐兆万,王炳武,等.终板法置钉单运动元固定治疗胸腰椎骨折[J].中国脊柱脊髓杂志,2008,18(10):730-734.
(收稿日期:2015-07-13) (本文编辑:欧丽)