胸腰段脊柱爆裂骨折不同内固定方式的比较研究

Comparative study of different internal fixations in treatment of thoracolumbar burst fracture

目的 :评价不同内固定器械的三维稳定性和对椎管的减压作用 ,为今后临床胸腰段脊柱爆裂骨折的治疗提供依据。方法 :通过对13例中、重度胸腰段脊柱爆裂骨折标本进行不同内固定器械的固定 ,判断和观察脊柱节段的三维稳定性、椎管减压情况和椎间植骨的固定作用。结果 :Steffee,Kaneda器械可使重度爆裂骨折在屈曲、后伸及侧弯方向上较好地恢复脊柱的稳定性 ;Harrington在后伸时可保持稳定 ,在前屈、侧弯时虽优于Luque ,但与正常对照无明显差异(P<0.05) ;在旋转方向上 ,除Kaneda外的其余器械与正常对照的差异明显(P<0.05)。当椎间植骨后 ,除Luque外的所有器械节段的稳定性明显增加 ,但轴向旋转也仅有Kaneda能阻止节段的活动。除后伸活动外 ,Luque器械与其余器械组对节段的稳定作用的差异有统计学意义(P<0.05或P<0.01)。结论 :严重爆裂骨折以前路减压、植骨及Kaneda最理想 ;Steffee即可保持节段稳定 ,又可使椎管间接减压 ;Harrington的稳定作用不甚理想 ,但对椎管减压最佳 ;Luque无稳定和减压作用 ,应避免使用 ;脊柱前中柱植骨可防止继发后凸畸形和器械固定失败。

Objective: To evaluate the effects of internal fixation with different instruments. Methods: Thirteen injured segments with severe and moderate burst fracture were fixed by different instruments. The fixation effects of the instruments and intervertebral bone grafts on segment fixation were investigated by analysis of the 3 dimensional stability and their decompression of the spinal canal. Results: Treatment with Steffee or Kaneda instruments could well restore the stability of the spine in directions of flexion, posterior extension and lateral bend. Fixation with Harrington could keep the stability in the direction of posterior extension and was superior to Luque in maintaining the stability in directions of flexion and lateral bend, which were not significantly different as compared with the control group (P>0.05). In maintaining the stability of rotation, all of the instruments could only reduce the rotation of the injured segment by different degrees. However, it still exceeded the movement limitation of normal specimen, showing significant difference (P<0.05) in comparison with the normal group except for Kaneda. After intervertebral bone plantation, all of the instruments could markedly increase the segmental stability except for Luque. But only Kaneda could limit the segmental movement in axial rotation. Conclusion: Use of anterior pathway decompression, bone plantation and Kaneda instrument may be the best treatment for severe burst fracture. Steffee instrument can maintain the segmental stability and cause indirect decompression of the spinal canal. The fixation with Harrington is not effective, but shows the best benefit in decompression of the spinal canal. Luque is not beneficial for fixation and decompression. Bone plantation can prevent secondary posterior deformity and failure of instrumental fixation.