椎弓根钉棒系统治疗胸腰椎骨折临床效果分析（附74例报告）

发布时间：2018-02-21 21:13

本文关键词： 椎弓根螺钉胸腰椎骨折脊髓损伤矢状面Cobb角椎体前缘压缩率　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:总结分析采用椎弓根螺钉内固定治疗胸腰椎骨折的临床效果。方法:从2011年3月至2014年9月采用椎弓根钉棒系统复位内固定术治疗74例胸腰椎骨折患者,合并伤:脊髓损伤28例(37.8%),胸部损伤4例(5.4%),腹部损伤2例(2.7%),骨盆骨折2例(2.7%),四肢骨折21例(28.4%)。对合并脊髓损伤患者,术前给予营养神经、脱水等治疗,术中予椎管减压解除神经压迫,合并其他部位损伤患者,先治疗威胁生命的合并症,如血气胸、肝脾破裂等,待病情平稳,尽早对胸腰椎骨折行椎弓根钉棒系统复位内固定术。74例患者均术后定期随访1.5年以上直至取出内固定物后。对术前与术后1周内病椎椎体前缘压缩率、矢状面Cobb角进行疗效评价。在术后随访过程中至取出内固定后的各时间段,对病椎椎体前缘压缩率、矢状面Cobb角的变化进行观察比较。术前与术后1年脊髓损伤ASIA分级(American Spinal Injury Association impairment scale美国脊柱损伤协会损伤分级)进行对比分析。结果:(1)74例患者术前与术后1周内病椎椎体前缘压缩率与矢状面Cobb角,分别用配对t检验(P㩳0.05),认为手术可显著恢复压缩椎体的高度,纠正脊柱后凸畸形。(2)术后1周、3个月、1.5年以上、取出内固定物后各时间段病椎椎体前缘压缩率,用单因素重复测量方差分析(P㧐0.05),认为从椎弓根钉复位固定后到骨折愈合取出螺钉,病椎的高度变化无统计学意义。矢状面Cobb角从术后至取出内固定,采用单因素重复测量方差分析(P㩳0.05),认为矢状面Cobb角在随访过程中到取出螺钉后的各时间段,在总体上有差异。对各时间段矢状面Cobb角两两比较可观察到,取出内固定物前Cobb角的变化无显著差异(P0.009),取出后较取出前有升高(P㩳0.009),但与术前相比,仍有显著差异(P0.05)。(3)28例合并脊髓损伤患者,术前与术后1年ASIA分级采用等级资料秩和检验(P0.05),结合随访情况,可认为术后1年较术前脊髓功能明显恢复。结论:对于胸腰椎骨折采用经后路椎弓根钉棒系统复位内固定术,可以恢复伤椎的椎体高度,纠正脊柱后凸畸形,疗效确切。椎弓根钉棒系统在骨折愈合前为病椎提供坚强支持作用,可防止术后康复过程中病椎高度的丢失和脊柱后凸畸形。对于伴有脊髓损伤患者,通过手术复位固定骨折,可以缓解脊髓压迫,恢复脊柱的稳定性,有利于脊髓损伤的恢复和术后功能锻炼。
[Abstract]:Objective: to summarize and analyze the clinical effect of pedicle screw fixation in the treatment of thoracolumbar fractures. Methods: from March 2011 to September 2014, 74 patients with thoracolumbar fractures were treated with pedicle screw screw system reduction and internal fixation. Combined injury: spinal cord injury (n = 28), thoracic injury (n = 4), abdominal injury (n = 2), pelvic fracture (n = 2), limb fracture (n = 21), spinal cord injury (n = 28), spinal cord injury (n = 4), nutritional nerve and dehydration (n = 2). Decompression of the spinal canal during the operation to relieve the nerve compression, combined with other parts of the injury patients, the first treatment of life-threatening complications, such as hemopneumothorax, liver and spleen rupture, etc., to be stable, Thoracolumbar fractures were treated with pedicle screw system reduction and internal fixation as early as possible. 74 patients were followed up regularly for more than 1.5 years until the removal of internal fixation. The effect of sagittal Cobb angle was evaluated. The compression ratio of the anterior edge of the diseased vertebrae was evaluated during the follow-up period to the time after removal of the internal fixation. The changes of sagittal Cobb angle were observed and compared. The ASIA grade of spinal cord injury was compared with that of American Spinal Injury Association impairment scale before and one year after operation. Anterior compression ratio of vertebral body and Cobb angle of sagittal plane, The pairing t test was used to test the P? It is considered that the operation can significantly restore the height of compressed vertebral body and correct kyphosis deformity 1 week, 3 months, 1.5 years after operation. After removal of internal fixation, the compression ratio of the anterior edge of the diseased vertebral body is removed, and the ANOVA is repeatedly measured by single factor analysis of variance. From reduction and fixation of pedicle nail to the removal of screw from fracture healing, there was no significant change in height of the diseased vertebrae. Sagittal Cobb angle from postoperative to removal of internal fixation was determined by single factor repeated analysis of variance (ANOVA). It is considered that the sagittal Cobb angle varies from the follow-up period to the time after the removal of the screw. The sagittal Cobb angle can be observed in comparison with that of the sagittal plane Cobb angle in each time period. There was no significant difference in the Cobb angle before the removal of the internal fixator (P0.009), but there was a higher P0. 009 after removal than before removal. However, there were still significant differences between preoperative and preoperative ASIA scores in 28 patients with spinal cord injury. One year before and one year after operation, the rank data rank sum test was used to test P0.05 and follow up. Conclusion: for thoracolumbar fractures, posterior pedicle screw and rod system reduction and internal fixation can restore the height of injured vertebrae and correct kyphosis deformity. The pedicle screw and rod system can provide strong support to the diseased vertebrae before fracture healing, which can prevent the loss of the height of the diseased vertebrae and kyphosis during postoperative rehabilitation. For the patients with spinal cord injury, the fracture can be fixed by surgical reduction. It can relieve the compression of spinal cord, restore the stability of spinal column, and benefit the recovery of spinal cord injury and postoperative functional exercise.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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