胸腰椎骨折伤椎置钉临床疗效评估及椎体前缘高度丢失原因分析
| 作者: |
1徐海栋,
1史新瑞,
1刘刚,
1许斌
1 南京军区南京总医院骨科，南京 210002 |
| 通讯: |
许斌
Email: xuzongbin@hotmail.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.01.006 |
| 基金: | 南京军区医学科技创新课题, 12MA080 南京军区南京总医院军事医学培育课题, YYMS2014002 |
摘要
目的：胸腰椎骨折是常见的脊柱骨折，采用经伤椎椎弓根螺钉后路矫形内固定手术已经成为比较成熟的临床治疗方案，分析其临床疗效及矫形后近期椎体高度丢失对提高脊柱重建生物力学效果具有重要意义。方法：回顾性研究2012年至2013年就诊于南京军区南京总医院诊断为胸腰椎骨折的患者(胸10-腰2)36例，采用后路经伤椎椎弓根螺钉矫形内固定手术治疗，术后进行每3个月定期随访，记录不同时间点患者腰背痛VAS评分、椎体前缘高度比、伤椎后凸Cobb角。通过CT评估脊柱骨折愈合后取出内固定，建议患者术后1年随访，记录上述指标。结果：所有患者均顺利完成矫形手术、内固定取出手术，并完成内固定取出手术后1年门诊随访，记录不同时间患者的各项评估指标。和术前相比，VAS评分、椎体前缘高度比、伤椎后凸Cobb角明显改善并能有效保持(P<0.05)；取出内固定术后，患者的椎体前缘高度比、伤椎后凸Cobb角有所丢失(P<0.05)。结论：通过分析椎体前缘高度丢失原因，治疗近期疗效与胸腰椎节段特殊的生物力学因素、椎间盘损伤后的应力传递改变等密切相关。对于胸腰椎骨折矫形手术内固定取出后，仍需要对患者进行康复指导及必要的支具保护，从而维持良好的手术效果。
关键词：
胸腰椎骨折
脊椎内固定术
VAS评分
椎体前缘高度
脊柱后凸
临床疗效
The clinical curative effects of transpedicular internal fixation of fractured vertebrae in the treatment of thoracolumbar spinal fracture and causes analysis of fanterior vertebral body height lost
CorrespondingAuthor: XU Bin Email: xuzongbin@hotmail.com
DOI: 10.3978/j.issn.2095-6959.2016.01.006
Abstract
Objective: Thoracolumbar fractures are common spinal fractures. Using an injured vertebral pedicle screw internal fixation of the posterior orthopedic surgery clinical treatment has become more mature. Analyzing the clinical curative effect and short-term vertebral height loss after orthopaedic surgery has great significance in improving the effect of spinal biomechanical reconstruction. Methods: We retrospectively analyzed 36 cases of thoracolumbar vertebral fracture patients (10-thoracic 2-lumbar) who were diagnosed in Nanjing General Hospital of Nanjing Military from 2012 to 2013. Fixation at the fractured vertebra via paravertebral intermuscular approach was used. Postoperatively regular follow-up every 3 months was conducted. Low back pain VAS score in different time points, fanterior vertebral body height ratio, and vertebral kyphosis Cobb angle of the patients were recorded. Internal fixation was taken out after spine fracture healing once passing the CT evaluation. Patients were suggested to do the postoperative follow-up of 1 year and in the meantime record the above mentioned indexes. Results: All patients successfully completed orthopaedic surgery and internal fixation removal surgery. 1 year follow-up of all petients after internal fixation removal surgery is completed. The researchers recorded the evaluation indexes of patients in different time. Compared with preoperative results, VAS score, fanterior vertebral body height ratio vertebral kyphosis Cobb angle improved obviously and kept effective (P<0.05). After removing the internal fixation, patients’ fanterior vertebral body height ratio and vertebral kyphosis Cobb angle lost relatively (P<0.05). Conclusion: After analyzing the causes of fanterior vertebral body height loss, we conclude that short-term clinical curative effect and thoracolumbar segments special biomechanical factors, stress transfer changes of intervertebral disc after injury are closely related. To maintain the good operation effect, rehabilitation guidance for patients and necessary support protection are still needed after taking out the internal fixation of thoracolumbar fracture orthopaedic surgery.