短节段内固定在治疗胸腰椎爆裂骨折的临床疗效分析

发布时间：2018-03-02 12:16

本文选题：胸腰椎　切入点：爆裂骨折　出处：《山东中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察后路短节段椎弓根内固定系统治疗胸腰段爆裂骨折的疗效,对其进行科学评价,并探讨影响预后的相关因素,为临床提供理论依据,寻找疗效更佳的治疗方案。方法:本研究以Frankel分级评分、VAS评分、Denis疼痛分级评估等为观察指标,结合术前、术后的影像学(X光片、CT、MRI)表现,对92例胸腰段爆裂骨折经后路椎弓根内固定系统治疗的病例,根据患者术前、术后1周及随访末期(全部患者术后随访6~12个月,平均随访9士3.2个月)结果,进行疗效分析与评价,并探讨影响其疗效的因素。结果:1、92例患者均在术后3~8周下床活动,未见内置物的松动、断裂,无椎体明显再压缩等。2、92例病人术后疼痛明显缓解(VAS评分和Denis疼痛分级改善),伤椎椎体高度恢复并维持良好,Cobb角以及椎体前缘高度的恢复情况较术前明显增高(P0.05),有统计学意义。3、通过多元分析,得出末次随访时影响患者ODI分值的相关因素为术前椎体压缩率、术后椎体压缩率和疼痛状况分级、年龄、骨质疏松。结论:1、后路短节段椎弓根内固定系统在不加大创伤的基础上,能显著恢复伤椎椎体高度,增加脊柱前中柱的抗压稳定性,使病人较早活动,有效防止术后矫正度丢失及椎体再塌陷的发生,随访疗效满意。2、影响其疗效的主要因素是术前术后椎体压缩率、患者腰背疼痛分级、术前骨质疏松的程度,术前术后椎体压缩率愈大疗效越愈,骨质疏松愈厉害预后愈差,年龄愈大疗效愈差,但与性别无明显关系。
[Abstract]:Objective: to observe the curative effect of posterior short segmental pedicle fixation system in the treatment of thoracolumbar burst fracture, to evaluate it scientifically, and to explore the related factors affecting prognosis, and to provide theoretical basis for clinical practice. Methods: in this study, Frankel grade and Frankel score and Denis pain grade were used as the observation index, combined with preoperative and postoperative CT imaging findings. 92 cases of thoracolumbar burst fracture treated by posterior pedicle internal fixation system were analyzed according to the results of preoperative, postoperative 1 week and the end of follow-up (all patients were followed up for 6 ~ 12 months on average 9 卤3.2 months). Analysis and evaluation of the curative effect were carried out, and the factors affecting the curative effect were discussed. Results 92 patients with 1 / 92 cases got out of bed 3 weeks after operation without loosening and breaking of the implant. In 92 patients without obvious recompression of vertebral body, the pain was significantly relieved after operation, and the scores of Denis and VAS were improved. The recovery of vertebral height of injured vertebrae was better than that of preoperation. The recovery of vertebral height and anterior height of vertebral body was significantly higher than that before operation (P 0.05). Statistical significance. 3, through multivariate analysis, The factors related to the ODI score of the patients at the last follow-up were vertebral compression ratio before operation, vertebral compression rate after operation and pain status classification, age, age, and age. Conclusion: the posterior short segment pedicle internal fixation system can significantly restore the vertebral body height of the injured vertebrae, increase the stability of the anterior and middle column of the spine, and make the patient move earlier. It was effective to prevent the loss of correction degree and the occurrence of vertebral recollapse after operation. The follow-up results were satisfactory. The main factors affecting the curative effect were the rate of vertebral compression before and after operation, the grade of pain in the patients' back and back, the degree of osteoporosis before operation, and the degree of osteoporosis before operation. The greater the effect of vertebral compression ratio before and after operation, the worse the prognosis of osteoporosis and the worse the effect of age, but there was no significant relationship between the effect and sex.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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