多节段腰椎骨折的临床治疗分析

A clinical study of pedicle screw implanting treatment of multi-level lumbar fractures

[目的]复习一组应用TSRH-3D椎弓根螺钉系统复位并椎弓根内固定治疗多节段腰椎骨折病人的临床资料,探讨该技术对腰椎骨折复位及内固定的治疗效果及远期疗效。[方法]本组18例,应用TSRH-3D椎弓根螺钉系统复位并椎弓根内固定治疗多节段腰椎骨折,均于伤后4 h～2 d内手术,所有患者均得到随访,随访时间15～32个月,平均23个月。均于术前、术后、末次随访时拍摄脊柱正侧位X线片、CT片。[结果](1)本组12例(67%)为高处坠落伤,5例(28%)为车祸伤,1例(5%)为挤压伤;(2)脊柱活动改善率为67%;腰背痛改善率为94%;下肢疼痛改善率为78%;(3)与术前相比,伤椎前缘高度平均矫正59.2%,平均丢失5.2%(P<0.01);Cobb′s角平均矫正19.5°,平均丢失5.4°(P<0.01)。[结论]采用TSRH-3D椎弓根螺钉内固定系统治疗多节段腰椎骨折对损伤节段可有满意的复位及内固定效果,有利于恢复脊柱伤椎高度、生理弧度和神经功能以及消除腰腿痛,有较好的远期疗效。

[Objective]To review the clinical data on patients suffering from multi-level lumbar spine fracture treated with TSRH-3D pedicle screw system,and to investigate the post-operative efficacy.[Method]Eighteen patients with multi-level lumbar spine fracture were treated with TSRH-3D pedicle screw system.The operations were performed 4 hours to 2 days after injury,and the follow-up period was 15-32 months（average,23 months）.The X-ray and CT scan were taken preoperatively and postoperatively.[Result]（1）Twelve patients injured from height falling（67%）,5 from traffic accident（28%） and 1 from crush injury（5%）.（2）The improvement rates of the spine motion,back pain and the lower extremity pain were 67%,94% and 78%,respectively.（3） Compared with preoperation,the height of anterior border of vertebra improved by 59.2%,lost by 5.2% on average（P〈0.01） and the Cobb′s angle was corrected by 19.5°,lost by 5.4°in average.[Conclusion]It is feasible to treat the multi-level lumbar spine fracture with TSRH-3D pedicle screw system.The outcome of reduction and fixation has been improved.This technique is good at improving the height of the injured vertebras,physiological radian and the neural function.It has a good effect in relieving lumbocrural pain and has a good long-term postoperative efficacy.