经伤椎置入椎弓根螺钉内固定修复胸腰椎骨折的可行性评价
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经伤椎置入椎弓根螺钉内固定修复胸腰椎骨折的可行性评价
屈鹏;王文己
【摘 要】背景：传统修复单椎体胸腰椎骨折常采用跨伤椎4钉固定，由于存在“平行四边形效应”及“悬挂效应”，容易发生内固定失败，复位高度及矫正角度丢失等并发症，而经伤椎椎弓根钉内固定，可避免或减少上述并发症发生。目的：探讨经伤椎椎弓根螺钉置入内固定修复单椎体胸腰椎骨折的可行性。方法：回顾性分析兰州大学第一医院骨科2013年1月至2014年6月收治的单节段胸腰椎骨折患者23例，损伤节段为T11-L2，平均年龄47.8岁，所有患者均在受伤后10 d内接受后路伤椎椎弓根螺钉和相邻上下椎椎弓根螺钉6枚螺钉内固定治疗，观察修复效果，包括术后短期并发症、椎体前缘高度比值及后凸Cobb角，以及脊髓神经功能损伤恢复情况。结果与结论：23例患者随访4-15个月，所有病例治疗后短期内(4-15个月)均未出现严重并发症，末次随访未出现钉棒断裂及内固定松动等情况。治疗后及末次随访所测得椎体前缘高度比值及后凸 Cobb 角均较治疗前明显改善，差异有显著性意义(P <0.05)，两项指标末次随访与治疗后相比稍有反弹，但差异无显著性意义(P >0.05)。末次随访时大部分患者脊髓神经功能有所恢复。提示经伤椎椎弓根螺钉置入内固定修复单节段胸腰椎骨折，能够有效恢复伤椎高度及矫正后凸畸形，并能保持矫正效果，钉棒断裂发生率低，优势明显。%BACKGROUND:Traditionaly repairing single vertebral thoracolumbar
fracture often uses of cross-vertebral 4 screw fixation. Because of
“paralelogram effect” and the “suspension effect”, it is prone to have
internal fixation failure, reset height and correction angle loss, and other
complications. However, these complications can be avoided or reduced
by fractured vertebra pedicle screw fixation. OBJECTIVE:To investigate the feasibility evaluation of pedicle screw fixation for repairing thoracolumbar
fracturevia fractured vertebrae. METHODS:A total of 23 patients with single
segment thoracolumbar fractures treated at the First Hospital of Lanzhou
University between January 2013 and June 2014 were retrospectively
analyzed. The fractured segments were between T11 to L2, the patient’s
average age was 47.8 years old. Al the patients received the posterior
pedicle screws and adjacent and up and down six pedicle screw internal
fixation within 10 days after injury. The repair effect was observed,
including short-term postoperative complications, vertebral height ratio,
Cobb angle and the recovery of spinal neurological function. RESULTS
AND CONCLUSION:Twenty-three cases were folowed up for 4 to 15
months. Al patients had no severe complications in the short term (4
to 15 months) after treatment. There was no screw rod breakage or
internal fixation loosening at the last folow-up. The vertebral height ratios
and Cobb angle which were measured in postoperative and final folow-up
were significantly improved compared with the preoperative data (P <
0.05). The two indicators had a slight rebound in the last folow-up
compared with that after treatment, but the difference was not significant
(P> 0.05). The spinal neurological functions of most patients were partialy
recovered at the last folow-up. These results suggest that pedicle screw
embedding fixation repairing thoracolumbar fractureviafractured vertebrae
can effectively restore vertebral height and correct kyphosis, and maintain
correction effect. The advantages are obvious with a low occurrence rate of
pedicle screw fracture. 【期刊名称】《中国组织工程研究》
【年(卷),期】2015(000)044
【总页数】6页(P7125-7130)
【关键词】骨科植入物;脊柱植入物;胸腰椎骨折;经伤椎;椎弓根螺钉;Cobb角;内固定
【作 者】屈鹏;王文己
【作者单位】兰州大学第一医院骨科，甘肃省兰州市 730000;兰州大学第一医院骨科，甘肃省兰州市 730000
【正文语种】中 文
【中图分类】R318
文章亮点：
1经试验结果可以得出经伤椎椎弓根螺钉置入内固定修复胸腰椎骨折在伤椎复位、纠正后凸畸形方面效果良好，并能有效的保持复位效果，维持矫正后Cobb角，通过减压能够在一定程度上改善神经功能，增强脊柱稳定性，有利于术后早期下地活动，减少早、晚期并发症的发生。
2伤椎椎弓根螺钉的置入在对胸腰椎固定的稳定性、矫正后椎体高度及Cobb角的保持方面均优于跨伤椎椎弓根螺钉固定，但其也存在一些缺点，手术时间的增加及出血量的增多务必会导致手术感染率的增加；经伤椎6钉固定的稳定性及强度明显优于跨伤椎4钉固定，但随着内固定强度及刚度的增加，势必会引起或加速临近节段退变。因此关于伤椎椎弓根螺钉的固定，仍需进一步、大样本、长期随访的临床研究来证实结论。 目的：探讨经伤椎椎弓根螺钉置入内固定修复单椎体胸腰椎骨折的可行性。
方法：回顾性分析兰州大学第一医院骨科2013年1月至2014年6月收治的单节段胸腰椎骨折患者23例，损伤节段为T11-L2，平均年龄47.8岁，所有患者均在受伤后10 d内接受后路伤椎椎弓根螺钉和相邻上下椎椎弓根螺钉6枚螺钉内固定治疗，观察修复效果，包括术后短期并发症、椎体前缘高度比值及后凸Cobb角，以及脊髓神经功能损伤恢复情况。
结果与结论：23例患者随访4-15个月，所有病例治疗后短期内(4-15个月)均未出现严重并发症，末次随访未出现钉棒断裂及内固定松动等情况。治疗后及末次随访所测得椎体前缘高度比值及后凸Cobb角均较治疗前明显改善，差异有显著性意义(P<0.05)，两项指标末次随访与治疗后相比稍有反弹，但差异无显著性意义(P>0.05)。末次随访时大部分患者脊髓神经功能有所恢复。提示经伤椎椎弓根螺钉置入内固定修复单节段胸腰椎骨折，能够有效恢复伤椎高度及矫正后凸畸形，并能保持矫正效果，钉棒断裂发生率低，优势明显。
屈鹏，王文己.经伤椎置入椎弓根螺钉内固定修复胸腰椎骨折的可行性评价[J].中国组织工程研究，2015，19(44):7125-7130.
OBJECTIVE:To investigate the feasibility evaluation of pedicle screw fixation
for repairing thoracolumbar fracture via fractured vertebrae.
METHODS:A total of 23 patients with single segment thoracolumbar
fractures treated at the First Hospital of Lanzhou University between
January 2013 and June 2014 were retrospectively analyzed.The fractured
segments were between T11to L2,the patient’s average age was 47.8
years old.All the patients received the posterior pedicle screws and
adjacent and up and down six pedicle screw internal fixation within 10
days after injury.The repair effect was observed,including short-term postoperative complications,vertebral height ratio,Cobb angle and the
recovery of spinal neurological function.
RESULTS AND CONCLUSION:Twenty-three cases were followed up for 4 to
15 months.All patients had nosevere complications in the short term(4 to
