后路经椎弓根固定治疗胸腰椎骨折165例分析

Analysis of 165 cases of posterior pedicle screw fixation in the treatment of thoracolumbar fracture

目的分析后路经椎弓根固定治疗胸腰椎骨折的方法,探讨减少术后松动、断钉等并发症的有效措施。方法对比测量165例胸腰椎骨折术前术后脊柱后凸角度以及压缩椎体高度的变化;分析内固定松动、断裂发生的原因。结果 165例胸腰椎骨折患者术前后凸角度平均27.5°,术后平均5.3°;椎体术前平均高度42.6%。术后恢复至92.6%;术后随访平均1.6年,取出内固定时发现大部分内固定有松动现象。AF发生断钉11例,GSS0例;使用支具断钉2例,未用支具断钉7例。结论后路经椎弓根固定是治疗胸腰椎骨折较好的方法;术前准确把握手术指针;术中尽量恢复椎体高度与序列并结合植骨;术后结合支具保护下锻炼能有效减少松动断钉并发症的发生。

Objective To analyze the method of posterior pedicle screw fixation for thoracolumbar fractures, and to explore effective measures to reduce postoperative loose screw breakage complications. Methods A comparative measuring of 165 cases of Cobb angle and vertebral compression height changes in thoracolumbar fractures preoperative and postoperative; and making an analysis of the causes. Results The preoperative Cobb angle is an average of 27.5 °, and an average of 5.3 ° postoperative in the 165 cases of thoracolumbar fractures; the preoperative average vertebral height is42.6% and the postoperative is recovered to 92.6% in average; Postoperative follow-up visits in an average of 1.6 years founding out most of them loosening when removing the internal fixation. 11 cases of AF occurrence of broken nails occurred, and 0 cases of GSS; 2 cases of broken nails is using brace, the unused has 7 cases of broken nails. Conclusion Posterior pedicle screw fixation is a better way to treat thoracolumbar fractures; Grasping preoperative surgical pointer accurately, don't over-distraction reduction in surgery and emphasize bone grafting, postoperative exercise combined with brace protection can effectively reduce loose screw breakage complications.