胸腰椎骨折合并严重脱位手术治疗中固定节段数目的选择.pdfVIP

176 实用预防医学 2008年2月 第 15卷 第1期 Practical Preventive Medicine，Feb．2008，Vol 15，No．1 文章编号：1006 3110(2008)01—0176—03 胸腰椎骨折合并严重脱位手术治疗中 固定节段数目的选择 刘 云 ，李 晶 摘要： 目的 探讨经椎弓根螺钉固定节段数目的多少对严重的胸、腰椎脱位一骨折复位程度和维持稳定性能力的 影响，以确定对这类损伤治疗时合理的固定方法。 方法 回顾性分析 45例严重的胸、腰椎脱位 一骨折患者的治疗结 果，其中12例用4枚椎弓根螺钉(2椎体植钉)同定，11例用 6枚螺钉(3椎体植钉)，22例用8～9枚螺钉(4～5椎休植钉) 固定。比较4枚螺钉固定和6～9枚螺钉固定方法住复位程度和中、远期维持脊椎稳定能力的差别。 结果 12例用传 统的方法即4椎弓根枚螺钉固定的患者脱位均末纠正，术后随访5月～2年发现内 定均断裂松动及后凸畸形，并且有2 例出现侧方脱位加重。而用改进的方法即6～9枚椎弓根枚螺钉复位固定的33例患者不论是前后脱位还是侧方脱位均 达到完全纠正，随访2～5年见3例内固定物断裂，复位无丢失，无后凸畸形。 结论 对严重的胸腰椎脱位一骨折患者 应采用6～9枚椎弓根螺钉复位固定，以增强复位能力和维持脊柱稳定性的能力从而确保恢复脊柱的正常排列和牢固的 融合。 关键词： 胸腰椎；脊柱；脱位一骨折；内固定 中图分类号：R655 文献标识码：A Determination of Fixed Segmental Numbers in Treatment of Severe Thoracic or Lumbar Spine Dislocation—fracture L U Yun． LI Jing(Department of Orthopaedics，the First People’S Hospital of Yueyang，Yueyang 414000，Hunan) Abstract： Objective To explore the reasonable pedicle—screw numbers to be implanted into vertebrae and the num— bers of vertebrae tO be implanted in treatment of severe thoracic／lumbar spinal dislocation—fracture，and tO acquire complete reduction and effective maintenance of spinal stability． Method The treatment results of 45 patients with severe thoracic| lumbar spine dislocation—fractures were retrOspectively analyzed．Three methods were used as the following．Four pedicle— screws were implanted in 2 vertebrae in 12 patients(the fractured vertebra was bestrided，and this method was simplified as four—screw fixation)．Six pedicle—screws were implanted in 3 vertebrae in 1 1 patients(six—screw fixation)，and 8 to 9 pedicle—screws were implanted in 4 or 5 vertebrae in 22 patients．Between the 2 fixation methods，a comparison was made about the reduction degree，the ability to