侧前方钉板系统治疗胸腰椎骨折的围手术期处理_临床医学论文.docVIP

侧前方钉板系统治疗胸腰椎骨折的围手术期处理_临床医学论文 侧前方钉板系统治疗胸腰椎骨折的围手术期处理_临床医学论文 【摘要】 探讨侧前方钉板内固定系统治疗胸腰椎骨折的围手术期处理方法。［方法］根据胸腰段侧前方钉板内固定系统的内固定原理及植入要求在30例胸腰段椎骨标本上标出进钉点、进钉方向，并测量、观察其与周围易识别骨性标志的关系，为手术中测量、判断进钉点、进钉方向提供参考；根据60例胸腰椎骨折患者术前X线片及CT片，结合理论进钉点、进钉方向及内固定要求推算出螺钉、钢板长度、撑开高度及植骨块长度等指标的理论值作为术中使用的参考值，并在术中利用易识别骨性标志测量、判断进钉点、进钉方向；根据术中测量及术中或术后X线片评价进钉点、进钉方向、螺钉、钢板长度、撑开高度及植骨块长度等理论指标的准确性。［结果］术中测量、判断进钉点、进钉方向容易、准确、可靠；术前测量指标与术中、术后测量指标基本一致；60例患者术后脊柱结构、功能恢复良好，手术疗效满意。［结论］该围手术期处理方法科学、实用，对保证胸腰段侧前方钉板内固定系统成功植入，并减少手术并发症有较强的指导意义。 【关键词】 胸椎 腰椎 钉板系统 围手术期 侧前方入路 Abstract：［Objective］To discuss the perioperative management of thoracolumbar fractures fixed with latero［Method］The entry point and direction of screw on 30 thoracic and lumbar vertebra specimens were marked based on the principle and demand of implantation of lateroJanuary 2000 to June 2007.Reference data such as the length of vertebral body screw and plate and the height of bracing gotten from the patientsXray and CT findings before operation were compared with practical data measured during operation.The entry point and the direction of screw were determined exactly by anatomic landmarks of thoraco lumbar vertebrae and were checked by Xray during operation.［Result］The judgement of the entry point and the direction of screw was easy and accurate during operation and the reference data were in coincidence with practical data.The effects of operation were satisfactory.［Conclusion］The perioperative management is both scientific and practical.The surgical complications can be reduced in this way. Key words：thoracic vertebra; lumbar vertebra; screw 胸腰段侧前方钉板内固定系统由于固定牢靠，易于减压等因素在短节段胸腰段骨折的内固定中得到了越来越广泛的应用［1～3］,但也出现了不少并发症［4,5］:如进钉方向偏差甚至误入间盘或椎管，术后脊柱侧弯、后突畸形等。究其原因，在很大程度上与围手术期处理不当或不完善有关，笔者针对胸腰段骨折前路手术中发生的问题，在观察、测量胸腰段椎骨大体标本及患者X线片、CT片的基础上，总结出了胸腰段骨折前路手术的围手术期处理方法，经60例患者（2000年1月～2007年6月）临床应用后效果良好，现报道如下： 1 材料与方法 1.1 标本材料 30例正常成人胸腰段椎骨干燥标本（T10～L3）。 1.2 标本测量 根据胸腰段侧前方钉板内固定系统的固定螺栓植入要求在胸腰段椎骨标本上标出固定螺栓进钉点、进钉方向:即上位椎进钉点为经该椎体后缘前方8 mm之垂直线与经上缘下方8 mm之水平线的交叉点（图1）；下位椎进钉点为经该椎体后缘前方8 mm之垂直线与经下缘