经伤椎置钉短节段固定治疗胸腰椎骨折临床分析

目的:探讨伤椎置钉短节段固定治疗胸腰椎骨折患者的效果。方法:对86例胸腰椎骨折患者行椎弓根螺钉系统同时进行经伤椎置钉复位固定治疗。结果:所有患者均顺利完成手术,平均手术时间95.23±3.12min,平均出血量855.50±12.30ml;术后患者的椎体压缩百分比和Cobb角明显优于治疗前(P<0.05);患者术前、术后、术后1年的椎管矢状径占位率分别为(34.89±10.87)%、(5.29±4.68)%、(5.38±4.47)%,与术前比较差异具有统计学意义(P<0.05)。结论:后路经伤椎置钉短节段内固定手术治疗能够恢复胸腰椎骨折疗效显著。

椎体内植骨加后路钉棒固定治疗骨质疏松性胸腰椎压缩骨折68例

目的：探讨经后路椎板减压,钉棒内固定,伤椎内植同种异体骨在骨质疏松胸腰椎压缩骨折中的临床疗效。方法：对68例屈曲压缩型胸腰椎骨折行后路复位、钉棒内固定、经伤椎椎弓根植入同种异体骨粒,比较术后3周与术前伤椎后凸角及伤椎前缘高度,术后12月与术前伤椎后凸角及伤椎前缘高度。结果：术后经6-18月随访,平均12月,椎体前缘高度和后凸角无明显丢失,无内固定松动、断裂,神经功能平均提高1.2级,骨折平均愈合时间4.8月。术后3周及术后12月与术前伤椎后凸角及伤椎前缘高度比较差异均有统计学意义,术后3周与术后12月伤椎后凸角及伤椎前缘高度比较差异无统计学意义。结论：伤椎内植骨加后路钉棒固定在恢复椎体高度,加强伤椎前柱抗压能力,促进植骨愈合,避免远期并发症方面疗效确切。

3种内固定系统矫正特发性脊柱侧凸的疗效分析

目的:回顾性研究钉-棒系统矫正特发性脊柱侧凸的临床效果。方法:分别采用钩-棒、钉-钩-棒、钉-棒系统对469例特发性脊柱侧凸患者进行矫正,并对随访3年以上的303例分为3组,对其矫正效果、并发症进行对比研究。结果:钉-棒系统手术时间、出血量明显少于前两组。冠状面、矢状面的矫正中钉-棒系统明显优于前两组。术后钉-棒系统断棒、失代偿及假关节的发生明显低于前两组。结论:全椎弓根螺钉系统具有良好的三维矫正控制力,矫正效果良好,并发症少。

腰椎滑脱症患者术后滑脱椎体不同复位程度对疗效影响观察

目的：观察腰椎滑脱症患者经椎弓根螺钉系统内固定及椎间Cage植骨融合复位术后滑脱完全复位与部分复位的疗效差异。方法：选取腰椎滑脱症患者46例，均接受椎弓根螺钉系统内固定及椎间Cage植骨融合复位术。根据术后滑脱椎体的复位情况，分为完全复位组（25例）及部分复位组（21例）。通过测算椎体滑脱率、滑脱角、椎间盘指数、滑脱变化率、植骨融合率和进行JOA腰部功能评分等来评价。结果：46例患者术后获6～40个月随访。各组术后1周和末次随访的椎体滑脱率、椎间盘指数及末次随访JOA评分均优于术前，差异有统计学意义。各组术后1周和末次随访的滑脱角、椎间盘指数的比较，差异无统计学意义，而各组术后1周和末次随访的滑脱率比较差异有统计学意义。两组间在末次随访时比较滑脱变化率、植骨融合率、JOA评分优良率等比较，差异无统计学意义。结论：经椎弓根螺钉系统内固定及椎间Cage植骨融合复位的两组腰椎滑脱症患者，虽然复位程度不同，但均获得较好疗效，而且未发现不同复位程度对疗效有明显影响。

Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system： an analysis of 38 cases

Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.

Analysis of safety and effect of reconstructing anterior and middle columns by single posterior approach in treating lumbar burst fractures

Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases （18 males and 4 females, aged 28-57 years, 42.7 years on average） of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. Results： The average operation time was 3.5 hours （ranging 2.8-5.8 hours） and the average blood loss was 820 ml （ranging 650-2 100 ml）. All the cases were followed up for 17.2 months on average （ ranging 12-28 months）. The height of the injured vetebral body was restored from 24 % （12%- 45%） preoperatively to 96% （95%-99%） postoperatively （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. Conclusions： The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.