胸腰段骨折内固定对相邻椎体影响的临床应用研究

Clinical study of effect of internal fixation for thoracolumbar fracture with adjacent vertebral body

目的探讨椎弓根内固定术后邻近节段椎间隙变化的临床意义。方法选择该院9例胸腰段骨折(L1)病例,对使用TRSH椎弓根螺钉内固定治疗后的患者术前摄片(前屈20度,后伸80度),并且和正常组同节段的椎间隙高度进行比较。结果在该实验组所研究的9例患者中,在前屈状况下,内固定组与正常组相比,邻近椎间隙的高度下降幅度明显,差异有非常显著性意义(P<0.05);同样在后伸状况下,内固定组邻近节段椎间隙高度和正常组相比明显增加,差异也有非常显著性意义。结论脊柱内固定术后,固定节段内的刚度增加,活动幅度明显下降或消失,导致脊柱节段活动度将发生重分配,固定节段的活动会转移到其他的运动节段,因而邻近节段活动度增大。这种累积效应的增加容易促使邻近节段退变的发生及加重,这在生物力学中也得到验证。

[Objective] To approach intervertebral space height loss of neighbourhood segment clinical significance. [Method] We chosed nine example cases of thoracolumber fracture （T12） in our hospital, chosed patients of TRSH lateral mass of vertebrae hah and ahead route, compared the same segment intervertebral space height after operation X- RAY with before operation X--RAY. [Results] In the nine patients which were researched, circa diastemalii height of internal fixation obviously descend compared with common group, and discrepancy has significance. [Conclusion] In ontefexlo operation, as same as behind after interfixation operation, rigidity increases, activity descends or disppears. Coalesce segement activity will be reclistfibated, activity of coalesce segment will transfer resulting in circa segement increase. This unavoidably make circa segement cataplasis. All these were validated in biomechanics too.