桡骨远端关节内粉碎性骨折内外联合固定的手术疗效.DOCVIP

临床医学论文-桡骨远端关节内粉碎性骨折内外联合固定的手术疗效 ???????????????? ?作者：李健，肖斌，赵洪普，高梁斌，范震波? 【摘要】? ［目的］评价经伤椎椎弓根钉固定结合经椎弓根植骨治疗胸腰椎爆裂骨折的临床疗效，探讨其适应证。［方法］对30例胸腰椎爆裂骨折患者实施经伤椎椎弓根钉固定结合经椎弓根植骨术治疗，其中男22例，女8例，年龄18～64岁。30例均为单一椎体损伤。术前伤椎前缘高度平均35％，脊柱后凸角（Cobb角）26°，椎管正中矢状径55％，神经功能按Frankel分级：A级4例，B级8例，C级5例，D级6例，E级7例。［结果］术后随访6～30个月，30例患者术后疼痛明显缓解（VAS评分改善），术后伤椎前缘平均高度恢复到97％，脊柱后凸角（Cobb′s角）为3.5°，椎管正中矢状径恢复到92％，手术前后差异显著（P＜0.05）。术后神经功能恢复情况：A级2例，B级2例，C级5例，D级5例，E级16例。术后骨折均获得复位，无1例发生内固定断裂、松动、矫正丢失等并发症。［结论］经伤椎椎弓根钉固定结合经椎弓根植骨术能让骨折获得满意复位，重建椎体高度，增强脊柱的抗压稳定性，减少内固定因应力过大造成的断钉、矫正丢失等并发症，是一种治疗胸腰椎爆裂骨折的有效方法。 【关键词】? 胸腰椎损伤； 爆裂骨折； 椎弓根钉； 经椎弓根； 植骨术 ??? Abstract：［Objective］To investigate curative effect for thoracolumbar burst fractures by the method of vertebral pedicle screw fixation applied in the with transpedicular bone graft,and consider its indications.［Method］Thirty cases of thoracolumbar burst fractures were treated by vertebral pedicle screw fixation combining transpedicular bone graft.Among them 22 were male and 8 were famale,age ranged 18-64.All of cases were single segment fractures.The average height of anterior border was 35% before the operation,the average of Cobbs angle was 26?the percentage of midsagital diameter was 55%.According to Frankels neurological function classification,preoperative neurological function was Grade A in 4 cases,B in 8,C in 5,D in 6,E in 7.［Result］All cases were followed up for 6 to 30 months.All patients pain relieved distinctly,the average height anterior border was increased to 97%,the average of Cobbs angle was 3.5°,the percentage of midsagital diameter was 92% postoperatively,showing significant difference（P＜0.05）before and after operation.The postoperative neurological function was improved: Grade A in 2 cases,Grade B in 2,Grade C in 5,Grade D in 5,Grade E in 16.All the fracture were reduced and the internal fixation didnt loose and break,and there was no lost of correction and other complications.［Conclusion］Vertebral pedicle screw fixation with transpedicular bone graft can not only reduc