摘要 目的探讨后路过弯棒复位固定技术治疗不稳定新鲜胸腰椎爆裂骨折的安全性和有效性。方法回顾分析2018年1月—2019年10月符合选择标准的27例不稳定新鲜胸腰椎爆裂骨折患者临床资料。男15例,女12例;年龄26~64岁,平均41.8岁。致伤原因:高处坠落伤14例,交通事故伤8例,重物砸伤5例。受伤至手术时间1~7 d,平均3.2 d。损伤节段:T10 1例、T11 3例、T12 6例、L1 7例、L2 7例、L3 3例。按照AO分型标准,A3型11例、B型7例、C型9例。神经功能按照美国脊髓损伤协会(ASIA)分级:A级3例、B级7例、C级5例、D级12例。术中行后路过弯棒复位固定技术固定,其中16例联合有限开窗减压术。记录手术时间及术中出血量;比较手术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)以及椎弓根螺钉植钉准确率、伤椎椎管侵占率、椎体前缘高度压缩比、节段后凸Cobb角。结果手术时间67~128 min,平均81.6 min;术中出血量105~295 mL,平均210 mL。患者术后均获随访,随访时间12~23个月,平均17.2个月。术中共植入178枚椎弓根螺钉,植钉准确率为98.9%(176/178)。术后早期及末次随访时,伤椎椎体前缘高度压缩比较术前明显增加,椎管侵占率、后凸Cobb角以及VAS评分、ODI较术前明显降低,差异均有统计学意义(P<0.05);除ODI末次随访时较术后早期明显降低(P<0.05)外,其余指标末次随访与术后早期差异均无统计学意义(P>0.05)。末次随访时,ASIA分级为A级1例、B级2例、C级4例、D级9例、E级11例,与术前比较差异有统计学意义(Z=-3.446,P=0.001)。结论后路过弯棒复位固定技术能有效恢复伤椎前缘高度、复位侵入椎管骨折块,同时选择性行有限开窗减压及后外侧植骨,保证了椎管内减压的彻底性和脊柱稳定性,是治疗不稳定新鲜胸腰椎爆裂骨折的有效方法之一。 Objective To investigate the efficacy and safety of over-bending rod reduction and fixation technique via posterior approach in the treatment of unstable fresh thoracolumbar burst fracture. Methods A clinical data of 27 patients with unstable fresh thoracolumbar burst fracture, who were met the inclusive criteria and admitted between January 2018 and October 2019, was retrospectively analyzed. There were 15 males and 12 females with an average age of41.8 years(range, 26-64 years). The fractures were caused by falling from height in 14 cases, traffic accident in 8 cases, and crushing by a heavy objective in 5 cases. The interval between injury and operation was 1-7 days(mean, 3.2 days). The injured fracture was located at T10 in 1 case, T11 in 3 cases, T12 in 6 cases, L1 in 7 cases, L2 in 7 cases, and L3 in 3 cases.According to AO classification, there were 11 cases of type A3, 7 cases of type B, and 9 cases of type C. Neurological function was rated as grade A in 3 cases, grade B in 7 cases, grade C in 5 cases, and grade D in 12 cases according to the American Spinal Injury Association(ASIA) grading. All cases were treated by over-bending rod reduction and fixation technique via posterior approach, and 16 cases were combined with limited fenestration decompression. The evaluation indicators consisted of operation time, intraoperative blood loss, the compression ratio of the anterior vertebral height, the invasion rate of the injured vertebra into the spinal canal, the Cobb angle of segmental kyphosis, visual analogue scale(VAS) score, and Oswestry Disability Index(ODI). Results The operation time was 67-128 minutes(mean, 81.6 minutes), and the intraoperative blood loss was 105-295 mL(mean, 210 mL). All patients were followed up 12-23 months(mean, 17.2 months). A total of 178 pedicle screws were implanted during operation, and the accuracy of the implantation was 98.9%(176/178). The compression ratios of the anterior vertebral height at the early postoperatively and last followup were significantly increased when
机构地区 漯河市中心医院脊柱科
出处 《中国修复重建外科杂志》 CAS CSCD 北大核心 2021年第4期458-463,共6页 Chinese Journal of Reparative and Reconstructive Surgery
关键词 胸腰椎爆裂骨折 不稳定骨折 过弯棒复位固定技术 有限减压 复位 Thoracolumbar burst fracture unstable fracture over-bending rod reduction and fixation technique limited decompression reduction
分类号 R68 [医药卫生—骨科学]
