3种椎弓根内固定器械的临床应用

Clinical Application of the Three Kinds of the Apparatus of Pedicle Screw Fixation

目的 比较3种椎弓根内固定器械治疗胸腰椎骨折、腰椎滑脱的临床效果。方法 回顾分析采用Steffee、Dick、及SF内固定器械治疗的胸腰椎骨折、腰椎滑脱共计2 4 7例临床资料,对其中获得随访的2 2 1例术后效果、并发症及治疗前后X- ray改善情况作比较分析。结果 a) Steffee、Dick、SF3种椎弓根内固定器械治疗后神经功能改善率分别为6 0 .1% ,76 .1% ,90 .7% ;脊柱活动改善率分别为74 .4 % ,81.0 % ,92 .0 % ;腰背痛改善率分别为80 .5 % ,84 .1% ,92 .0 % ;下肢疼痛改善率分别为85 .4 % ,87.3% ,88.2 %。b)该3种治疗方法的定位错误率分别为4 .8% ,4 .7% ,2 .6 % ;螺丝钉断裂率分别为9.7% ,6 .3% ,3.9% ;螺钉及钉棒连接松动率分别为8.5 % ,7.9% ,3.9% ;一过性神经根性体征分别为9.7% ,4 .7% ,2 .6 %。c)骨折治疗组椎体高度矫正率分别为6 4 .5 % ,86 .0 % ,94 .7% ;融合节段Cobb′s角均值分别为2 1.5°,18.4°,6 .9°;滑脱组位移矫正率分别为84 .3% ,85 .4 % ,89.6 %。结论 a) SF内固定器在治疗胸腰椎骨折及腰椎滑脱的临床应用中效果优于Dick及Steffee。b)术中并发症的发生与掌握椎弓根内固定技术的熟练程度有关。

Objective To compare the clinical results of the three kinds of the apparatus of pedicle screw fixation for the treatment of spondylolisthesis and thoracolumbar fracture. Methods Total 247 patients that treated with the apparatus of Steffee, Dick and SF for spondylolisthesis and thoracolumbar fracture was reviewed of these, 221 cases were followed-up. Analyzed the results of after operation, the complication, the improvement of X-ray. Results a)After treatment of Steffee, Dick, SF the amelioration of nerve function was 60.1%, 76.1%, 90.7%; the improvement of spinal motion was 74.4%, 81.0%, 92.0%; the amelioration of low back pain was 80.5%, 84.1%, 92.0%; and the amelioration of leg pain was 85.4%, 87.3%, 88.2%. b)The rate of screw misplacement was 4.8%, 3.2%, 2.6%; the rate of screw breakage was 9.7%, 6.3%, 3.9%; the rate of screw-rod and screw-bone coupling failure was 8.5%, 7.9%, 3.9%; the rate of the symptom of temporary neuralgia was 9.7%, 4.7%, 2.6%. c)In the group of thoracolumbar fracture the rate of the improvement of the high of vertebra was 64.5%, 86.0%, 94.7%; the average of the kyphotic deformity after surgery was 21.5°, 18.4°, 6.9°. In the group of spondylolisthsis the mean reduction rate was 84.3%, 85.4%, 89.6%. Conclusion a)The clinical result of SF instrumentation for the treatment of spondylolisthesis and thoracolumbar fracture is better than Steffee and Dick. b)Perfect surgical technique is the key to reduce the incidence of complications.