椎弓根钉技术治疗不稳定性上胸椎损伤

Clinical research of pedicle screws fixation in treating upper unstable thoracic trauma

[目的]总结用后路椎弓根钉技术治疗不稳定性上胸椎损伤的临床经验、技术要点及临床效果。[方法]将应用椎弓根钉后路固定治疗的49例不稳定性上胸椎损伤病人的临床资料和随访资料进行分组总结,找出预防脊髓损伤、神经根损伤等并发症发生的有效方法。[结果]椎弓根钉技术可有效恢复脊椎的解剖结构,纠正上位脊椎的移位、成角畸形(P<0.05),促进脊髓损伤的恢复(P<0.05),脊髓损伤的概率低(P<0.05)。[结论]椎弓根钉技术治疗上胸椎不稳定性损伤是一种坚强、安全、有效的方法。

[ Objective] To sum up the experience, technique and initially clinical and radiographic results for the treatment of upper unstable thoracic trauma with pedicle screw technique, and try to find out the reasons for complications. [ Method ] The clinical and follow-up data of 49 cases of upper unstable thoracic trauma treated form Jan. 1998 to Jan. 2004 with pedicle screws and Rod system fixation were summarized. All the data were analyzed with NASS software in t and x^2 test. [ Result] This technique significantly resumed the anatomy construction of the injured upper thoracic column from subluxation and kyphotie deformity （ P 〈 0.05 ） except the burst fracture type. The in-hospital time and keep-in-bod time were reduced and postoperative kyphosis occurrence, complications and scoliosis were prevented. To measure the anatomy construction of the pedicles with CT preoperatively was one of the most important thing for using matched screws to fix pedicles. [ Conclusion ] The pedicle screw combined with Rod system is a reliable, safe and effective technique for treating upper unstable thoracic trauma, and it could be considered as an efficient alternative to previously reported techniques.