椎弓根内固定治疗合并脊髓损伤的胸腰椎骨折_医学论文.docVIP

椎弓根内固定治疗合并脊髓损伤的胸腰椎骨折_医学论文 椎弓根内固定治疗合并脊髓损伤的胸腰椎骨折_医学论文 【摘要】 探讨经后路短节段椎弓根内固定治疗合并脊髓损伤的胸腰椎骨折的临床疗效。［方法］分析本科自1999～2004年应用椎弓根内固定治疗合并脊髓损伤胸腰椎骨折并获完整随访的47例病例资料。通过影像学、神经功能及社会功能来综合评估疗效。［结果］47例患者平均随访51.9月(18～86个月)，伤椎前、后缘高度压缩率术前平均43.6％、71.4％，术后平均恢复至92.2％、96.4％，至末次随访时为88.3％、93.1％；Cobb′s角术前平均23.5°，术后矫正至4.3°，末次随访时为8.8°。椎管占位率术前、术后、随访时分别为：62.8％、11.4％、6.2％。脊髓不完全损伤的患者神经功能均有FrankeⅡ级以上的改善，61.7％的患者可继续从事伤前的社会工作。［结论］椎弓根内固定治疗合并脊髓损伤的胸腰椎骨折可重建脊柱稳定性，恢复脊柱正常序列，有利于神经功能恢复和植骨融合。 【关键词】 腰椎 脊髓损伤 椎弓根内固定 结果 Abstract：［Objective］To evaluate the outcome of thoracolumbar fracture with spinal cord injury treated with shortsegment pedicle instrumentation.［Method］47 cases of thoracolumbar fracture with spinal cord injury from 1999 to 2004 in our department were collected，all of them were treated with shortsegment pedicle instrumentation.The radiologic，neurologic，and functional outcome were assessed.［Result］All of the 47 cases were followed up，the mean followup were 51.9 months(18～ 86 months)，the average of vertebral anterior and posterior height were corrected from 43.6%，71.4% to 92.2%,96.4%and 88.3%，93.1% at the last followup separately.The Cobbs angle were corrected from 23.5°to 4.3°，and 8.8° at the last followup.62.8% of the vertebral canal was occupied preoperation，and 11.4% postoperation，6.2% at last followup.There was significant deference in targets between preoperation and postoperation (0.05)，and no significant deference between last followup and postoperation (Pgt0.05) .Neurologic status improved at least 1 Frankel grade in the patients who had preoperative incomplete paraplegia.61.7% of patients returned to work.［Conclusion］Shortsegment pedicle instrumentation can provide good reduction，strong fixation，complete decompression and fusion.The treatment outcome is good.Moreover，it is a less traumatic，simple and safe technique. Key words：thoracic vertebrae lumbar vertebrae spinal cord injury internal transpedicular fixation outcome 　 合并脊髓损伤的胸腰椎骨折一般需要手术治疗，以获得脊柱骨性和神经的稳定，并为神经功能的恢复创造理想的环境。短节段椎弓根螺钉系统