S-F内固定器治疗胸腰椎爆裂型骨折

The Treatment of Thoracolumbar Burst Fracture with S-F Spine Internal Fixation Device

目的 探讨使用S -F脊柱内固定器治疗胸腰椎爆裂型骨折的效果。方法 回顾分析从 2 0 0 0年 1月～ 2 0 0 2年 4月使用S-F脊柱内固定器治疗的胸腰椎爆裂型骨折 4 4例 ,比较手术前后的椎体前后缘高度 ,椎管狭窄程度 ,Cobb角及症状恢复情况。结果 经平均 2年左右的随访 ,术后椎体前缘平均高度达正常的 93 8%± 6 2 7% ,较术前增加了 4 2 5 3%。椎体后缘平均高度达到正常的 97 5 9%± 0 0 3% ,较术前增加了 1 6 5 2 %。脊柱后凸Cobb为 4 98°± 3 32°。较术前矫正了 1 4 6 8°。CT片显示椎体后突骨块占椎管前后径的比例为 9 5 9%± 7 2 1 % ,较术前减少 2 7 71 %。统计学分析差异有显著性 (P <0 0 5 )。有神经功能损伤者 ,术后平均改进一级以上。在术后二周与术后一年以上的X线片相比较其椎体前缘的高度平均仅丢失 1 0 % ,椎体后缘的高度平均丢失 0 8% ,Cobb角平均丢失 0 1°。结论 使用S -F脊柱内固定器治疗胸腰椎爆裂型骨折具有操作简单、复位完美、固定牢靠、疗效优良的优点。术中注意不宜过度撑开及双侧不对称 ,对椎板减压者宜作“H”型椎板后路植骨 ,横突间、关节突间植骨融合将提高疗效。

Objective In order to research on the treatment results of thoracolumbar burst fracture with S-F spine internal fixation device.Methods To analye and compare the heights of anterior and posterior vertebral body,the degree of spine canal stenosis,the Cobb angles and clinical symptom,forty four cases of thoraclumbar burst fracture with S-F spine internal fixation device have been reviewed and analyzed since January 2000 to April 2002.Results With the average followed up period of two years or so,the postoperative height of anterior vertebral body was 93 8±6 27 percent,comparing with the preoperative improved 42 53 percent and the height of posterior vertebral body was 97 59±3 03 percent,improved 16 52 percent.The postoperative average Cobb angles was 4 98±3 32 degrees.They have been improved by 14 68 degrees.The CT scans that the rates of the posterior herniation bone fragments of the vertebral canal by its front and back path was 9 59±7 21 percent,improved 27 71 percent.Statistically there has been significant difference (P<0 05 ) between them.The patient accompanying nevral deficiency presence had been improved more than one fraked grade.Compared the postoperative two weeks with one year the height of anterior and posterior vertebral body had only lost 1 0 percent and 0 8 percent,the Cobb angles had only lost 0 1 degree.Conclusion The treatment of thoracolumbar burst fracture with S-F spine internal fixation device has been proved many advantages,such as easy to operate,better to recuperate and firm internal fixation as well as exellent effect.Attention should be paid to both sides symmetry and not to spread excessively during operation.Those laminotomy who make “H” shape vertebral lamina back bone grafting,transverse process and articular process bone grafting fusion will have better effect and reduced its complication.