预弯棒预防胸腰椎骨折前路手术后侧方成角

Effectiveness of pre-flexed rod in preventing spinal lateral angulation after surgery for thoracolumbar fracture via anterior approach

[目的]分析预弯棒在预防胸腰椎骨折前路手术后脊柱出现侧方成角的效果。[方法]回顾性分析2010年9月~2015年6月本院胸腰椎骨折前路手术患者共218例,其中影像学资料完整的208例。评估每一位患者的影像资料,测量椎体螺钉与终板的夹角,208例中男139例,女69例,年龄16~68岁,平均(38.1±14.9)岁。损伤类型:车祸31例,重物砸伤23例,高处坠落伤154例。骨折椎体节段:T_(11)2例,T_(12)18例,L_1137例,L_241例,L_39例,L_41例;骨折椎体AO分型:A型194例,B型14例;脊髓损伤Frankel分级:A级53例,B级11例,C级35例,D级39例,E级70例。内固定材料:Antares(美敦力公司)197例和Z-Plate(美敦力公司)11例。208例中有20例术中通过预弯连接棒预防可能形成的侧方成角,20例中男14例,女6例,年龄28~53岁,平均(35.3±20.1)岁。损伤类型:车祸6例,重物砸伤1例,高处坠落13例。骨折椎体节段:T_(11)0例,T_(12)1例,L_115例,L_23例,L_31例;骨折椎体AO分型:A型20例;脊髓损伤Frankel分级:A级5例,B级1例,C级3例,D级4例,E级7例。内固定材料:全部应用Antares脊柱前路内固定系统(美敦力公司)。[结果]全部病例中有9例术后出现超过5°以上的侧方成角,没有10°以上的侧方成角。术前侧方成角平均1.31°±4.09°,术后侧方成角平均2.19°±3.78°,术前与术后冠状面Cobb角比较差异无统计学意义。20例应用预弯棒的患者术中均出现椎体螺钉与相应的终板较大的成角,但术后均没有出现超过5°以上的侧方成角。术前侧方成角平均2.11°±4.26°,术后侧方成角平均2.31°±3.58°,术前与术后冠状面Cobb角比较差异无统计学意义。[结论]预弯棒可以有效地预防胸腰椎骨折前路手术术后脊柱侧方成角的发生。

[Objective] To investigate the effectiveness of preflexed rod in preventing spinal lateral angulation after sur- gery for thoracolumbar fracture via anterior approach. [Methods] A retrospective analysis was performed in 218 patients with thoracolumbar fracture who underwent surgery via anterior approach in our hospital from September 2010 to June 2015. Of them, 208 patients induding 139 males and 69 females had complete imaging data,with a mean age of 38.1±14.9 years （ 16- 68 years） . The angle between vertebral screw and end plate was measured for every＂ patient. The causes of fracture were falling accident in 154 patients, traffic accident in 31 patients, and heavy pound injury in 23 patients. The fracture was at T. in 2 cases, T12 in 18 cases, L1 in 137 cases, L2 in 41 cases, L3 in 9 cases, and L4 in 1 case. According to the AO classifiea- tion system, 194 patients had type A fracture and 14 patients had type B fracture. According to Frankel assessment for neuro- logical status, 53 cases were at grade A, 11 cases at grade B, 35 cases at grade C, 39 cases at grade D, and 70 cases at grade E. Anterior fixation was performed with the Antares （Medtronic, Sofamor Danek） in 197 cases and the Z-Plate （Medtronic, Sofamor Danek） in 11 cases. Of the 208 patients, 20 patients including 14 males and 6 females with a mean age of （35.3±20.1） yea, （28-53 years） were treated with the prflexed rod during operation to prevent lateral angulation.The causes of fracture were falling accident in 13 patients, traffic accidents in 6 patients, and heavy pound injury in 1 patient. The fracture was at T12 in 1 case, L1 in 15 cases, L2 in 3 cases, and L3 in 1 case. All the 20 eases had type A fracture according to the AO classification system. According to Frankel assessment for neurological status, 5 cases were at grade A, l case at grade B, 3 cases at grade C, 4 cases at grade D, and 7 cases at grade E. Anterior fixation was performed with the Antares （Medtronic, Sofamor Danek） in all the 20 cases. [Results] A total of 9 cases showed a lateral angulation of 〉5°. However, no lateral angulation of 〉 10° was present. There was no significant difference in the coronal Cobb angle be- tween preoperation and postoperation （1.31°±4.09° vs 2.19°±3.78°, P 〉0.05） . All the 20 cases treated with the prcflexed rod had a big angle between the screw and the relevant end plate during operation. However, no lateral angulation of 〉5° was present ＇after operation. And there was no significant difference in the coronal Cobb angle between preoperation and postopera- tion （2.11°±4.26° vs 2.31°±3.58°, P 〉0.05） . [Conclusions] Preflex rod can effeetively prevent spinal lateral angulation after surgery for thoracolumbar fracture via anterior approach.