伤椎置钉治疗胸腰椎爆裂骨折临床探究.docVIP

伤椎置钉治疗胸腰椎爆裂骨折临床探究[摘要] 目的 探讨经伤椎置钉治疗胸腰椎爆裂骨折及维持后凸畸形矫形的有效性。 方法 2000年6月～2007年6月共68例，所有患者随机分为4组，每组17人。组1：单纯长节段固定；组2：长节段内固定+伤椎置钉；组3：单纯短节段固定；组4：单纯短节段+伤椎置钉。对所有患者术前、术后、随访期间的临床与放射性参数进行评估。 结果 平均随访47个月，未出现内固定松动或断裂现象。各组间年龄、骨折节段、随访时间以及载荷评分各指标无显著性差异（P 0.05），各组间手术时间、住院时间及失血量没有显著性差异（P 0.05），各组间术前后凸角接近（P 0.05）。术中后凸角矫正度数第4组最低，随访发现后凸角矫正维持效果以第1、2、4组较好。各组间术前椎体前缘平均高度百分比接近（P 0.05），第3组术后椎体前缘高度最高，第1、2、4组术后椎体前缘高度降低。 结论 同时经伤椎置钉椎弓根螺钉系统固定治疗胸腰椎骨折是一种行之有效的方法。伤椎置钉可获得并维持更好的后凸畸形矫正，其在短节段实用性更强。 [关键词] 伤椎置钉；胸腰椎；爆裂骨折 [中图分类号] R683.2 [文献标识码] B [文章编号] 1673—9701（2012）26—0053—03 The treatment of thoracolumbar burst fractures by the use of screws at the injury level GUAN Junhui RAN Bo ZHENG Wenbiao CHEN Fanghu LIAO Fei Department of Orthopedics， Taizhou Municipal Hospital in Zhejiang Provnince， Taizhou 318000， China [Abstract] Objective To evaluate the efficacy of fracture level screw in the treatment of thoracolumbar burst fractures and maintaining the kyphosis correction. Methods All of 68 patients were collected from June 2000 to June 2007. They were randomized divided into 4 groups with equal number of 17 patients. In group 1， patients were treated by simple long segmental posterior instrumentation； In group 2 they were treated as in group 1 with fracture level screw incorporation. In group 3， Patients were treated by short—segment posterior instrumentation；In group 4， they were treated as in group 3 with fracture level screw incorporation. Clinical and radiologic parameters were evaluated before surgery， after surgery， and at follow—up. Results The average follow—up was 47 months and the internal fixation did not become flexible and cracked.The preoperative kyphosis angle degree approximated each other among groups（P 0.05）. The kyphosis angle correction degree was the lowest in the third group in the operation（P = 0.036）. The average anterior vertebral height compression approximated each other among groups before the operation（P 0.05）. The anterior vertebral height compression was the high