USS椎弓根钉系统治疗下腰椎骨折

Treatment of lower lumbar fracture with the USS pedicel screw system

目的报告后路短节段USS椎弓根螺钉治疗L3-5骨折的临床效果。方法1992～2004年,共救治下腰椎骨折57例,其中21例采用USS椎弓根螺钉系统固定。L3骨折12例,L4骨折8例,L5骨折1例。所用椎弓根螺钉系统均为AO-USS创伤系统。术前、术后分别测量病变椎体高度、病变节段前凸角;CT片测量椎管占位率;以Frankel评分系统评价神经功能,以Charles等人的标准评价临床效果。结果本组手术时间90～150min,平均120min;出血量100～600mL,平均350mL;术前Frankel评分3.7分,术后4.5分;术前椎节高度为正常椎体的30%～60%,术后恢复至70%～100%,平均87%,术前腰椎前凸角35.2°±8.3°,术后38.3°±10.2°。患者离床下地时间3d～2周,恢复工作时间3～6周,随访3～30个月,平均15个月。结果优9例,良9例,可2例,差1例。结论采用USS短节段椎弓根螺钉固定治疗下腰椎骨折,具有有效恢复椎节高度、腰椎前凸及椎管容积,有效防止后期出现腰痛及椎管狭窄症状,可早日下地活动及重返工作岗位等优点。

Objective To report the clinical outcome of L3～L5 fractures treated with USS short segmental pedicel screw system. Methods From 1994 to 2004, 57 cases of lower lumbar fractures were treated, of which 21 cases were treated with USS pedicel screw system. There were 12 cases of L3 fracture, 8 cases of L4 fracture and 1 cases of L5 fracture. The intervertebral height and lumbar lordosis were evaluated both before and after operation, the spinal impingement of bone was evaluated on CT scan, the neurofunction was evaluated with Frankle system and the clinical outcomes were evaluated with Charles system. Results The operation time ranged from 90 min to 150 min, averaging 120 min. The bleeding volume ranged from 100 ml to 600 ml, averaging 350 ml. The Frankle scores increased from 3.7 to 4.5 after operation. The intervertebral height of the fractured vertebral body increased from preoperative 30%to 60%to postoperative 70%to 100%(averaging 87%). The lumbar lordosis angel increased from preoperative 35.2±8.3o to postoperative 38.3±10.2o. The mobilization time was 3d to 2w, and the time for resuming work was 3 to 6w. The 3 to 30 months follow ups (averaging 15m) showed that the clinical outcomes were excellent in 9 cases, good in 9 cases, fair in 2 in and poor in 1. Conclusion The advantages of treating the lower lumbar fractures with short segmental USS pedicel screw system are effective restoration of intervertebral body height, lumbar lordosis and spinal volume, prevention of long term lumbago and lumbar stenosis, as well as early mobilization and return to work.