撑开支具在胸腰段脊髓损伤患者早期康复中作用的影像学评价

The efficacy of thoracolumbar distraction brace in the early rehabilitation of spinal cord injury with X-ray tomography

目的:评价胸腰椎撑开支具在胸腰段脊髓损伤患者早期康复中的影像学表现。方法:自行研制胸腰椎撑开支具,25例患者均为胸腰段脊柱脊髓损伤术后第3-4周,分别在卧位无支具、卧位戴撑开支具和立位戴撑开支具等三种状态下拍摄胸腰椎正侧位CR片,分别测量损伤椎体的上一正常椎体前(后)下缘至上一正常椎体前(后)下缘的高度。结果:三种不同状态下损伤椎体的前缘高度分别是118.257±13.524mm、121.414±12.879mm、119.237±12.527mm,三者之间差异有显著性意义(P<0.01)。卧位戴撑开支具与卧位无支具、立位戴撑开支具相比差异均有显著性意义(P<0.01);卧位无支具与立位戴撑开支具相比差异无显著性意义(P>0.05)。三种状态损伤椎体的后缘高度差异无显著性意义(P>0.05)。结论:自行研制的胸腰椎撑开支具,能有效地与后路内固定器协同发挥减少自身体重对受损椎体的压力,增强受损脊柱的稳定性,保证早期康复训练的安全性。

Objective： To evaluate the clinical efficacy of thoracolumbar distraction brace in the early rehabilitation of spinal cord injury （SCI） with X-ray tomography. Method： Twenty-five cases with spinal fracture and SCI were treated with thoracolumbar distraction brace at the 3rd-4th week post-operation. All the patients were assessed with X-ray technique in the following three conditions： a, patients without distraction brace in decubitus position （nobrace-0°）. b, patients wearing distraction brace in decubitus position （brace-0°）. c, patients wearing distraction brace in upright position （brace-90°）. The pressure of the brace was 150N. The height from the anterior （posterior） inferior border of normal centrum vertebrae over the fractured one to the anterior （posterior） superior border of normal centrum vertebrae beneath the fractured one were measured. Result：The heights of anterior border of fractured vertebrae in three different conditions were 118.257±13.524mm, 121.414±12.879mm,119.237±12.527mm, respectively, and the difference was significant （P〈0.01）. The ＂brace-0°＂ exhibited significantly higher anterior border compared with other two conditions （P〈0.01）. While , there was no difference between ＂nobraee-0°＂ and ＂brace-90°＂（P〉0.05）. There was no significant difference in the heights of posterior border of fractured vertebrae between the three conditions（P〉0.05）.Conclusion： The thoracolumbar distraction brace can reduce the pressure of their own body weight on the fractured vertebrae as well as the internal fixation device in vertebral posterior,thus enhance the stability of damaged spinal column. Accordingly,in the premise of guaranteeing security, patients should begin seated training and upright training as soon as possible.