經(jīng)后路椎弓根釘棒系統(tǒng)內(nèi)固定聯(lián)合椎體后方蹬骨刀打壓植骨復(fù)位治療胸腰椎爆裂性骨折臨床療效分析
發(fā)布時(shí)間：2018-10-05 18:25
【摘要】：目的:探討經(jīng)后路椎弓根釘棒系統(tǒng)內(nèi)固定聯(lián)合椎管探查減壓蹬骨刀打壓植骨復(fù)位治療胸腰椎單節(jié)段爆裂性骨折臨床療效分析。方法:對(duì)從2012年3月到2013年06月我科收治的36例新鮮胸腰椎單節(jié)段椎體爆裂性骨折患者的臨床資料進(jìn)行回顧性分析。其中男24例,女12例,年齡22—50歲,平均(36.8±9.5)歲;致傷因素為高處墜落傷17例,車禍傷12例,重物砸傷7例;受損節(jié)段包括T11,6例,T12,12例,L1,10例,L2,8例;術(shù)前結(jié)合影像學(xué)檢查依照Denis分類法,均為爆裂性骨折;按改良Frankel神經(jīng)功能分級(jí)標(biāo)準(zhǔn)評(píng)定:A級(jí)4例,B級(jí)8例,C級(jí)10例,D級(jí)14例;受傷時(shí)間至手術(shù)時(shí)間:2d—9d,平均5.4d。給予經(jīng)后路椎弓根釘棒系統(tǒng)內(nèi)固定,椎管探查減壓,于椎弓根內(nèi)側(cè)緣傷椎后方行鐙骨刀打壓蹬移復(fù)位,傷椎植骨強(qiáng)化。手術(shù)方法:采用后正中入路,以傷椎為中心作切口,顯露傷椎及其上、下臨近椎體的椎板、關(guān)節(jié)突、橫突等,暴露椎弓根螺釘進(jìn)釘點(diǎn),C型臂X線機(jī)透視指引下確定進(jìn)釘點(diǎn),在傷椎及臨近椎體內(nèi)置入6枚合適椎弓根螺釘,通過(guò)后路撐開(kāi)器試行撐開(kāi)復(fù)位矯正脊柱序列,臨時(shí)固定。根據(jù)情況行半椎板開(kāi)窗或者全椎板切除減壓,用神經(jīng)剝離子牽開(kāi)硬脊膜,從椎弓根內(nèi)側(cè)緣探至后縱韌帶,創(chuàng)建工作通道,經(jīng)該通道用椎管內(nèi)復(fù)位器鐙骨刀對(duì)傷椎進(jìn)行打壓蹬移復(fù)位,傷椎植骨強(qiáng)化,解除椎管內(nèi)占位,透視滿意后鈦棒加壓固定植骨融合復(fù)位。結(jié)果:手術(shù)時(shí)間130—180分鐘,平均150分鐘;術(shù)中出血量210—700ml,平均(390.0±15.5)ml;所有患者均獲得隨訪,末次隨訪未發(fā)現(xiàn)或提示有內(nèi)固定松動(dòng)、斷裂、移位等情況,骨折椎體愈合及高度恢復(fù)滿意,完整取出內(nèi)固定器,未見(jiàn)螺釘鈦棒松動(dòng)、斷裂。傷椎前緣高度比由術(shù)前的平均55.42±2.64%恢復(fù)到末次隨訪的92.16±1.06%(P0.01),傷椎穩(wěn)定高度比由術(shù)前的平均33.94±1.34%恢復(fù)到末次隨訪為89.10±1.37%(P0.01),矢狀面Cobb角由術(shù)前平均25.95°±2.27°恢復(fù)到術(shù)后的3.26°±0.52°(P0.01)。隨訪期間傷椎前緣高度比、傷椎穩(wěn)定高度比、矢狀面Cobb角平均分別丟失2.87%、3.96%、2.65°。采用A S I A(American Spinal Injury Association)評(píng)分和改良Frankel神經(jīng)功能分級(jí)標(biāo)準(zhǔn)評(píng)估神經(jīng)功能改善情況。36例不完全神經(jīng)損傷患者末次隨訪脊髓神經(jīng)功能均有改善,恢復(fù)1級(jí)以上的患者有30例,占所有恢復(fù)病例數(shù)的83.3%。無(wú)術(shù)中神經(jīng)損傷及術(shù)后損傷加重等并發(fā)癥。疼痛、腰背部功能應(yīng)用VAS評(píng)分、ODI功能障礙指數(shù)、JOA評(píng)分進(jìn)行評(píng)估,均較術(shù)前有明顯改善。日常生活活動(dòng)能力運(yùn)用FIM評(píng)分和Barthel指數(shù)評(píng)估,末次隨訪均較術(shù)前有明顯改善。結(jié)論:應(yīng)用經(jīng)后路椎弓根釘棒系統(tǒng)內(nèi)固定聯(lián)合椎體后方蹬骨刀打壓植骨復(fù)位治療胸腰椎單節(jié)段爆裂性骨折,能有效地恢復(fù)傷椎高度、改善后凸畸形、重建脊柱序列。同時(shí)安全有效地進(jìn)行椎管前方減壓,解除脊髓壓迫、恢復(fù)血供利于術(shù)后神經(jīng)功能及腰背部功能的恢復(fù)。但尚須大宗病例的積累及長(zhǎng)期隨訪驗(yàn)證。
[Abstract]:Objective: to investigate the clinical effect of posterior pedicle screw system internal fixation combined with exploration of spinal canal decompression and pedal knife compression and bone grafting in the treatment of thoracolumbar single level burst fracture. Methods: the clinical data of 36 cases of fresh thoracolumbar vertebral burst fracture treated in our department from March 2012 to June 2013 were retrospectively analyzed. There were 24 males and 12 females, aged 22-50 years, with an average age of (36.8 鹵9.5) years. According to Denis classification, all cases were burst fractures, 4 cases of grade A and 8 cases of grade B, 10 cases of grade D and 14 cases of grade D were assessed according to modified Frankel classification standard, and the time of injury to operation was 2 d to 9 days, with an average of 5.4 days. The posterior pedicle screw and rod system were fixed, the spinal canal was decompressed by exploration and decompression, and the stapes knife was used to press and push the pedicle at the posterior of the medial edge of the pedicle, and the injured vertebrae was strengthened with bone graft. Methods: the posterior median approach was used to expose the lamina, articular process and transverse process of the injured vertebrae and its upper and lower vertebrae through the incision centered on the injured vertebrae. The point of entry was determined under the guidance of the C-arm X-ray machine under the guidance of exposure of pedicle screw entry point and C-arm X-ray machine. Six suitable pedicle screws were inserted into the injured and adjacent vertebrae. According to the situation, half lamina fenestration or total laminectomy and decompression were performed. The dura mater was opened with nerve dissection, and the posterior longitudinal ligament was found from the medial margin of pedicle to create a working channel. With the stapes knife in the spinal canal, the injured vertebrae were reduced by compression and pedal, the injured vertebrae were strengthened with bone graft, the space occupied in the spinal canal was relieved, and the fusion reduction of titanium rod compression fixation and bone graft fusion was achieved after the fluoroscopy was satisfied. Results: the operative time was 130-180 minutes (mean 150min), the amount of intraoperative bleeding was 210-700ml (mean 390.0 鹵15.5ml) and all the patients were followed up. No internal fixation loosening, breakage and displacement were found or indicated in the last follow-up. Fracture vertebral body healing and high recovery satisfactory, complete removal of internal fixator, no screw titanium rod loosening, fracture. The anterior height ratio of the injured vertebrae recovered from 55.42 鹵2.64% before operation to 92.16 鹵1.06% at the last follow-up (P0.01), the ratio of stable height of the injured vertebra recovered from 33.94 鹵1.34% to 89.10 鹵1.37% (P0.01), and the sagittal plane Cobb angle recovered from 25.95 擄鹵2.27 擄preoperatively to 3.26 擄鹵0.52 擄(P0.01). During the follow-up period, the anterior height ratio of the injured vertebra, the stable height ratio of the injured vertebra, and the sagittal Cobb angle lost 2.87 and 3.96 degrees respectively. The improvement of neurological function was evaluated by A S I A (American Spinal Injury Association) score and modified Frankel criteria. All the 36 patients with incomplete nerve injury were followed up for the last time, and 30 patients recovered to grade 1 or more. It accounted for 83.3% of all cases recovered. There were no complications such as nerve injury during operation and severe injury after operation. Pain, lumbar and back function were evaluated with VAS score and dysfunction index (VAS), which were significantly improved compared with those before operation. Activities of daily living (ADL) were evaluated with FIM score and Barthel index. Conclusion: the treatment of thoracolumbar single level burst fracture with posterior pedicle screw and rod fixation combined with posterior pedicle bone knife reduction can effectively restore the height of injured vertebrae, improve kyphosis deformity and reconstruct spinal sequence. At the same time, decompression of anterior spinal canal, decompression of spinal cord and restoration of blood supply are beneficial to the recovery of postoperative nerve function and lumbar and back function. However, the accumulation of large numbers of cases and long-term follow-up should be verified.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2254410
[Abstract]:Objective: to investigate the clinical effect of posterior pedicle screw system internal fixation combined with exploration of spinal canal decompression and pedal knife compression and bone grafting in the treatment of thoracolumbar single level burst fracture. Methods: the clinical data of 36 cases of fresh thoracolumbar vertebral burst fracture treated in our department from March 2012 to June 2013 were retrospectively analyzed. There were 24 males and 12 females, aged 22-50 years, with an average age of (36.8 鹵9.5) years. According to Denis classification, all cases were burst fractures, 4 cases of grade A and 8 cases of grade B, 10 cases of grade D and 14 cases of grade D were assessed according to modified Frankel classification standard, and the time of injury to operation was 2 d to 9 days, with an average of 5.4 days. The posterior pedicle screw and rod system were fixed, the spinal canal was decompressed by exploration and decompression, and the stapes knife was used to press and push the pedicle at the posterior of the medial edge of the pedicle, and the injured vertebrae was strengthened with bone graft. Methods: the posterior median approach was used to expose the lamina, articular process and transverse process of the injured vertebrae and its upper and lower vertebrae through the incision centered on the injured vertebrae. The point of entry was determined under the guidance of the C-arm X-ray machine under the guidance of exposure of pedicle screw entry point and C-arm X-ray machine. Six suitable pedicle screws were inserted into the injured and adjacent vertebrae. According to the situation, half lamina fenestration or total laminectomy and decompression were performed. The dura mater was opened with nerve dissection, and the posterior longitudinal ligament was found from the medial margin of pedicle to create a working channel. With the stapes knife in the spinal canal, the injured vertebrae were reduced by compression and pedal, the injured vertebrae were strengthened with bone graft, the space occupied in the spinal canal was relieved, and the fusion reduction of titanium rod compression fixation and bone graft fusion was achieved after the fluoroscopy was satisfied. Results: the operative time was 130-180 minutes (mean 150min), the amount of intraoperative bleeding was 210-700ml (mean 390.0 鹵15.5ml) and all the patients were followed up. No internal fixation loosening, breakage and displacement were found or indicated in the last follow-up. Fracture vertebral body healing and high recovery satisfactory, complete removal of internal fixator, no screw titanium rod loosening, fracture. The anterior height ratio of the injured vertebrae recovered from 55.42 鹵2.64% before operation to 92.16 鹵1.06% at the last follow-up (P0.01), the ratio of stable height of the injured vertebra recovered from 33.94 鹵1.34% to 89.10 鹵1.37% (P0.01), and the sagittal plane Cobb angle recovered from 25.95 擄鹵2.27 擄preoperatively to 3.26 擄鹵0.52 擄(P0.01). During the follow-up period, the anterior height ratio of the injured vertebra, the stable height ratio of the injured vertebra, and the sagittal Cobb angle lost 2.87 and 3.96 degrees respectively. The improvement of neurological function was evaluated by A S I A (American Spinal Injury Association) score and modified Frankel criteria. All the 36 patients with incomplete nerve injury were followed up for the last time, and 30 patients recovered to grade 1 or more. It accounted for 83.3% of all cases recovered. There were no complications such as nerve injury during operation and severe injury after operation. Pain, lumbar and back function were evaluated with VAS score and dysfunction index (VAS), which were significantly improved compared with those before operation. Activities of daily living (ADL) were evaluated with FIM score and Barthel index. Conclusion: the treatment of thoracolumbar single level burst fracture with posterior pedicle screw and rod fixation combined with posterior pedicle bone knife reduction can effectively restore the height of injured vertebrae, improve kyphosis deformity and reconstruct spinal sequence. At the same time, decompression of anterior spinal canal, decompression of spinal cord and restoration of blood supply are beneficial to the recovery of postoperative nerve function and lumbar and back function. However, the accumulation of large numbers of cases and long-term follow-up should be verified.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
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，本文編號(hào)：2254410
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