复杂胸腰椎骨折伤椎置钉技术探讨与形态分析

Morphological Features of Complicated Thoracolumbar Fractures and the Fixation Technology to the Injured Vertebra

目的:为了研究复杂胸腰椎骨折手术后的伤椎置钉技术以及伤椎的形态特点。方法:回顾性分析2008年3月～2010年11月我院收治的62例胸腰椎骨折患者,骨折AO分型均为B型或C型;Franke1脊髓损伤分级为A级38例,B级10例,C级4例,D级6例,E级4例。将手术病例按置钉位置的不同分为伤椎置钉组32例和非伤椎置钉组30例。术前、术后X线片检查分析伤椎形态特点、置钉后伤椎后凸角度、伤椎前后缘高度比、伤椎移位比的矫正与丢失情况;利用Denis评分评价术后下腰痛和工作恢复情况。结果:所有患者均获随访,随访时间18～38月,平均随访时间为26.8月。伤椎置钉组在伤椎的矫正角度丢失情况及前后缘高度比丢失情况均少于伤椎未置钉组(P<0.05);伤椎置钉组的伤椎移位比例也较伤椎未置钉组为少(P<0.05);术后Denis疼痛评分显示伤椎置钉组与伤椎未置钉组差异有统计学意义(P<0.05)。结论:复杂胸腰椎骨折手术采用伤椎置钉技术可以很好地纠正椎体骨折畸形,术后更有利于维持损伤椎体的稳定性。

Objective： To study the morphological feature of complicated thoracolumbar fractures and the fixation technology of injured vertebra. Methods： Reviewed 62 patients who were treated by our hospital from March 2008 to November 2010,and 62 cases were belonged to type B and C thoracolumbar fractures according to AO classification. Based on Frankel grading system of spine deficit： Grade A Was found in 38 cases, grade B in 10 cases, Grade C ha 4 cases, Grade D in 6 cases and Grade E in 4 cases.All the patients were divided into two groups：32 cases with pedicle screws in the injured vertebra and 30 cases without pedicle screw in the injured vertebra. The analyses on the morphological features of injured vertebra were performed, and comparisons were carried out on the omcome regarding the reduction and correction of the injured vertebra, and the difference of Denis scale m pain domain and work status domain between the two groups. Results： All the patients were followed up for an average of 26.8 months（range 18 to 38 montbs）.There were significance statistical difference in the correction loss of Cobb angle, sagittal index, correction of dislocation index, and the Denis pain scale between the two groups（P〈0.05）,A better outcome Was observed in the injured vertebra fixation group than the injured vertebra non-fixation group. Conclusion： Inserting pedicle screws in the injured vertebra is effective and useful in the correction of complicated thoraeolumbar fractures, it can improve the biomechanical stability of the spine after operation.