椎弓根钉技术治疗不稳定性上胸椎损伤_医学论文.docVIP

椎弓根钉技术治疗不稳定性上胸椎损伤_医学论文 椎弓根钉技术治疗不稳定性上胸椎损伤_医学论文 作者：李孟军　闫新海　李亮 褚秀成 武新远 高擎书 【关键词】 上胸椎损伤 摘要：［目的］总结用后路椎弓根钉技术治疗不稳定性上胸椎损伤的临床经验、技术要点及临床效果。［方法］将应用椎弓根钉后路固定治疗的49例不稳定性上胸椎损伤病人的临床资料和随访资料进行分组总结，找出预防脊髓损伤、神经根损伤等并发症发生的有效方法。［结果］椎弓根钉技术可有效恢复脊椎的解剖结构，纠正上位脊椎的移位、成角畸形(005)，促进脊髓损伤的恢复(005)，脊髓损伤的概率低(005)。［结论］椎弓根钉技术治疗上胸椎不稳定性损伤是一种坚强、安全、有效的方法。 　　关键词：上胸椎损伤；椎弓根钉；外科学 　　Clinical research of pedicle screws fixation in treating upper unstable thoracic trauma 　　Abstract：［Objective］To sum up the experience, technique and initially clinical and radiographic results for the treatment of upper unstable thoracic trauma with pedicle screw technique, and try to find out the reasons for complications.［Method］The clinical and followup data of 49 cases of upper unstable thoracic trauma treated form Jan. 1998 to Jan. 2004 with pedicle screws and Rod system fixation were summarized. All the data were analyzed with NASS software in t and x2 test. ［Result］This technique significantly resumed the anatomy construction of the injured upper thoracic column from subluxation and kyphotic deformity ( P ＜0.05 ) except the burst fracture type. The inhospital time and keepinbed time were reduced and postoperative kyphosis occurrence, complications and scoliosis were prevented. To measure the anatomy construction of the pedicles with CT preoperatively was one of the most important thing for using matched screws to fix pedicles.［Conclusion］The pedicle screw combined with Rod system is a reliable, safe and effective technique for treating upper unstable thoracic trauma, and it could be considered as an efficient alternative to previously reported techniques. 　　Key words Upper unstable thoracic trauma Pedicle screws Orthopaedic surgery 　　不稳定性上胸椎损伤主要由高度暴力造成，在脊柱损伤中约占10％，多合并脊髓损伤，由于上胸椎椎弓根变异大、缺乏解剖定位标志，常发生螺丝钉位置偏差引起脊髓和神经根损伤［1］。本研究对1998年1月~2004年1月应用椎弓根钉技术治疗上胸椎损伤患者49例病人进行随访，进行了总结分析，报告如下。 　　1 材料与方法 　　11 一般资料 　　本组共49例，男38例，女11例，年龄14~67岁，平均296岁；T18例，T2 6例，T3 9例， T4 11例，T5 15例，伤后距手术时间3±246d；损伤类型：屈曲压缩型13例，爆裂骨折17例，安全带性损伤4例，骨折脱位型15例。ASIA2002版［2］标准