经伤椎置钉技术治疗严重胸腰椎C型骨折.docVIP

·临床论著· 经伤椎置钉技术治疗严重胸腰椎C型骨折 张建政 刘智 任继鑫 韩力 徐宇航 王晓伟 孙天胜 DOI:10.3760/cma.j.issn.1671-7600.2014.06.000 作者单位：100700 北京军区总医院全军创伤骨科研究所 通信作者：刘智，E-mail：liuzhi.8002@163.com 【摘要】 目的 探讨伤椎置钉技术治疗伴有前、后纵韧带及椎间盘破裂的严重胸腰椎C型骨折的可行性和有效性。 方法 回顾性分析2008年1月至2012年4月收治的16例伴有前、后纵韧带及椎间盘破裂的胸腰椎C型骨折患者资料，男14例，女2例；年龄21～65岁，平均35.1岁。通过观察脊柱序列脱位的特点和伤椎骨折的特点，比较术前、术后即刻、术后1年视觉模拟评分（VAS）和影像学随访结果，评估伤椎置钉技术治疗伴有前、后纵韧带及椎间盘破裂的胸腰椎C型骨折脊柱序列复位、伤椎骨折复位程度。 结果 16例患者术后获12～48个月随访，手术时间平均为（241.3±45.1）.5) mL、术后引流血量平均为(271.8±131.7) mL、住院时间平均为(13.3±6.7) d。伤椎置钉技术后脊柱序列复位更完全，术后即刻和术后1年的VAS评分、伤椎前缘高度丢失率、伤椎前后滑脱率、矢状面cobb角和椎管占位率交术前均有明确改善，差异有统计学意义（P＜0.05），但术后即刻与术后1年差异无统计学意义（P＞0.05）。 结论 合并前、后纵韧带断裂及椎间盘破裂的严重胸腰椎C型骨折伤情特殊，伤椎置钉技术有助于提高脊柱序列的复位质量和增加后路系统的力学稳定性。 【关键词】；；pplication of intermediate screw technology on thoracolumbar Margerl type C fractures Zhang Jiangzheng, Liu Zhi, Ren Jixin, et al. Department of Orthopaedic Surgery, General Hospital of Beijing Military Command, Beijing 100700, China 【Abstract】 Objective To review our experience with direct reduction and fixation through the pedicle of fractured vertebra in the treatment of thoracolumbar Margerl type C Fractures complicated with longitudinal ligaments and intervertebral disc rupture. Methods From Jan 2008 to Apr 2012, sixteen patients with thoracolumbar Margerl type C fractures were operated by intermediate segment fixation with one or two additional screws in the fractured vertebra and followed-up in our division. Patients were evaluated at 1, 3, 6, 12 months after surgery, and then every year postoperatively. The outcomes were analyzed in terms of kyphosis angle, anterior height compression rate, dislocation, the radius vector of the spinal canal, and Frankel classification. Results All patients were followed-up for an average of 27.8 months (range, 12-48 months). All fractures gained bone fusion, and no broken screws, deaths or nerve injury aggravation occurred. There is no statistically significant difference in Frankel grade of nerve function after operation (P ＞0.05)