Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture_West China Medical Journal

Authors：

SONG Jingang ¹ , MIAO Yan ² , CUI Yikun ¹ , YIN Zhenyu ¹ , HUANG Haifeng ¹ , ZHAO Bing ¹

1. Department of Orthopedics, Central Hospital of Mianyang City, Mianyang, Sichuan 621000, P. R. China; 2. Department of Orthopedics, People’s Hospital of Mianyang City, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

Keywords：

胸腰椎骨折; 椎弓根钉; 伤椎; 内固定

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目的　探讨经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。方法　2008年5月－2010年12月，选择38例胸腰椎骨折患者，采用椎弓根螺钉固定伤椎及相邻上下椎体。其中男28例，女10例；年龄21～65岁，平均36.5岁。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受伤至手术时间3～7 d，平均4.5 d。对患者手术前后椎体高度、矢状面后凸Cobb角、神经功能Frankel分级变化等指标进行测量并随访。结果　术后患者切口均Ⅰ期愈合。38例获随访12～18个月，平均15个月。骨折均获得骨性融合，无钉棒断裂、无死亡或神经损伤加重患者。术后神经功能Frankel分级较术前有明显改善（P＜0.05）。术后X线片复查示伤椎高度恢复达90%以上，外形正常；CT复查示椎管内有效矢状径恢复满意，椎管前方无明显骨性压迫，伤椎椎体骨愈合良好。术后1、12个月时伤椎前、后缘高度及后凸Cobb角均较术前显著改善（P＜0.05）；术后12个月随访椎体高度无丢失。结论　经伤椎椎弓根钉复位、减压、内固定治疗胸腰椎骨折具有创伤小、固定节段少、脊柱稳定性好、能有效矫正及预防脊柱后凸畸形等优点。

Citation： SONG Jingang,MIAO Yan,CUI Yikun,YIN Zhenyu,HUANG Haifeng,ZHAO Bing. Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture. West China Medical Journal, 2012, 27(8): 1146-1149. doi: Copy

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6.	Park WM, Park YS, Kim K, et al. Biomechanical companson of insIrumentation techniaues in treatment Of thoracolumbar burst fraclures: a finite elementanalysis[J]. J Orthop Sci, 2009, 14(4): 443-449．.
7.	Liu S, Li H, Liang C, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(1): 38-44．.
8.	Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J]. J Spinal Disord, 1994, 7(5):402-407.
9.	宋无进, 蔡锦方．胸腰段骨折不同固定方式的有限元分析[J].中国组织工程研究与临床康复, 2009, 13(52): 10269-10273．.
10.	Whang PG, Vaccaro AR, PoeIstra KA, et al. The influence of Fracture mechanism and morpholoqy on the reliability and validity of two novel thoracolumbar injury classification systems[J].Spine (Phila Pa 1976), 2007, 32(7): 791-795．.
11.	吕夫新, 黄勇, 张强, 等.胸腰椎骨折伤椎椎弓根内固定生物力学研究与临床应用[J]. 脊柱外科杂志, 2008, 6(4): 229-234.
12.	王洪伟, 李长青, 周跃, 等. 脊柱骨折经伤椎椎弓根置钉附加横连短节段固定的稳定性测试[J]. 中国脊柱脊髓杂志, 2010, 20(9): 745-749.
13.	王洪伟, 李长青, 周跃, 等. 伤椎置钉技术治疗胸腰椎骨折的生物力学及临床随访研究[J].中国脊柱脊髓杂志, 2011, 19(16): 1356-1360.
14.	Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(6): 417-421.
15.	黄海多, 杨有猛, 卢家灵.椎弓根螺钉内固定间接减压治疗胸腰椎骨折疗效观察[J].临床骨科杂志, 2008, 11(5): 446-449.
16.	刘鹏, 李远安, 赵建华, 等.后路短节段固定融合术选择性治疗胸腰段爆裂性骨折[J]. 创伤外科杂志, 2008, 10(4): 333-336.
17.	王文孝, 丁全峰, 张晓琴. 胸腰椎骨折椎弓根钉固定术后矫正度丢失的原因分析[J]. 中国脊柱脊髓杂志, 2002, 12(3): 186.
18.	Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures[J]. Spine (Phila Pa 1976), 2005, 30(3): E73-79.

1. 　Bailey CS, Dvorak MF, Thomas KC, et al. Companson of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial[J]. J Neurosurg Spine, 2009: 11(3): 295-303．.
2. 　Ragel BT, Allred CD, Brevard S, et al. Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices[J]. Spine (Phila Pa 1976), 2009, 34(22): 2400-2455．.
3. 　殷军, 李爱民, 王宁, 等. 短节段加伤椎固定结合硫酸钙填充治疗胸腰椎爆裂骨折[J] . 中国脊柱脊髓杂志, 2011 , 21 (7) :561-565.
4. 　Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation[J]．J Spinal Disord Tech, 2010, 23(5): 293-301．.
5. 　Wei FX, Liu SY, Liang CX, et al. Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short- segment instrumentation[J]. Spine (Phila Pa 1976), 2010, 35(15): 714-720．.
6. 　Park WM, Park YS, Kim K, et al. Biomechanical companson of insIrumentation techniaues in treatment Of thoracolumbar burst fraclures: a finite elementanalysis[J]. J Orthop Sci, 2009, 14(4): 443-449．.
7. 　Liu S, Li H, Liang C, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(1): 38-44．.
8. 　Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J]. J Spinal Disord, 1994, 7(5):402-407.
9. 　宋无进, 蔡锦方．胸腰段骨折不同固定方式的有限元分析[J].中国组织工程研究与临床康复, 2009, 13(52): 10269-10273．.
10. 　Whang PG, Vaccaro AR, PoeIstra KA, et al. The influence of Fracture mechanism and morpholoqy on the reliability and validity of two novel thoracolumbar injury classification systems[J].Spine (Phila Pa 1976), 2007, 32(7): 791-795．.
11. 　吕夫新, 黄勇, 张强, 等.胸腰椎骨折伤椎椎弓根内固定生物力学研究与临床应用[J]. 脊柱外科杂志, 2008, 6(4): 229-234.
12. 　王洪伟, 李长青, 周跃, 等. 脊柱骨折经伤椎椎弓根置钉附加横连短节段固定的稳定性测试[J]. 中国脊柱脊髓杂志, 2010, 20(9): 745-749.
13. 　王洪伟, 李长青, 周跃, 等. 伤椎置钉技术治疗胸腰椎骨折的生物力学及临床随访研究[J].中国脊柱脊髓杂志, 2011, 19(16): 1356-1360.
14. 　Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(6): 417-421.
15. 　黄海多, 杨有猛, 卢家灵.椎弓根螺钉内固定间接减压治疗胸腰椎骨折疗效观察[J].临床骨科杂志, 2008, 11(5): 446-449.
16. 　刘鹏, 李远安, 赵建华, 等.后路短节段固定融合术选择性治疗胸腰段爆裂性骨折[J]. 创伤外科杂志, 2008, 10(4): 333-336.
17. 　王文孝, 丁全峰, 张晓琴. 胸腰椎骨折椎弓根钉固定术后矫正度丢失的原因分析[J]. 中国脊柱脊髓杂志, 2002, 12(3): 186.
18. 　Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures[J]. Spine (Phila Pa 1976), 2005, 30(3): E73-79.

West China Medical Journal

Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture

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