腰椎骨折短节段内固定时间对固定未融合节段退变的影响

发布时间：2018-05-23 07:54

本文选题：腰椎骨折 + 短节段　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的:通过对使用后路短节段内固定术治疗的腰椎A型骨折患者进行研究,研究不同内固定取出时间对固定未融合节段的影响。方法:回顾性研究宁夏医科大学总医院脊柱骨科2013年9月～2016年9月期间应用后路短节段椎弓根螺钉内固定融合术治疗的腰椎骨折病例80例,其中男性45例,女性35例,年龄32～55岁,平均38岁;随访时间12～24月,平均18月;致伤原因:坠落伤30例(37.5%),交通事故伤35例(43.8%),摔伤5例(6.2%),重物砸伤10例(12.5%);骨折节段:均为单节段骨折,其中:L1骨折32例(40%),L2骨折25例(31.3%),L3骨折18例(22.5%),L4骨折5例(6.2%),L5骨折0例(0%);骨折类型:按照AO分型,全部为A型骨折,其中A1型49例(61.2%),A2型26例(32.5%),A3型5例(6.3%);所有患者均无脊髓、神经损伤。根据术后内固定取出时间分为两组:A组:术后一年取内固定者,共40例;B组:术后二年取内固定者,共40例。80例患者均在骨折术前及内固定取出后行腰椎正侧位X线片、CT、MRI检查。X线片上测量骨折术前、内固定取出后伤椎前、中、后缘高度、椎体楔变角,末次测量值与骨折术前测量值之差为纠正丢失值;观察腰椎骨折术前、内固定取出后腰椎CT与MRI图像,应用Weishaup影像分级标准评价固定未融合节段小关节退变,用Modic退变标准、Pfirrmann分级系统评价固定未融合节段终板退变及椎间盘退变情况。应用SPSS17.0软件进行分析,比较2组固定未融合节段的退变差异。结果:1.A组及B组患者椎体楔变角矫正丢失值分别为1.42±1.26和2.83±2.09;A组及B组患者内固定取出后与骨折术前AVH、MVH、PVH和椎体楔变角相比,除术前MVH(P=0.095)、MVH矫正丢失(P=0.057),2组数据无统计学差异,余各组数据比较,差异均具有统计学差异(P0.05)。2.A、B两组患者骨折术前和内固定取出后固定未融合节段小关节退变比较差异具有统计学意义(P0.05);A、B两组患者骨折术前和内固定取出后固定未融合节段椎间盘退变比较差异具有统计学意义(P0.05);A、B两组患者骨折术前和内固定取出后固定未融合节段终板退变比较差异具有统计学意义(P0.05)。3.腰椎A型骨折短节段内固定术后1年取内固定与术后2年取内固定患者相比,固定未融合节段均有不同程度退变,但术后1年较术后2年取出内固定能有效减缓固定未融合节段退变。结论:后路短节段内固定术治疗腰椎A型骨折临床疗效满意;术后1年取出内固定能有效减缓固定未融合节段退变。
[Abstract]:Objective: to study the effect of different removal time of internal fixation on the unfused segment of lumbar vertebrae A fracture treated by posterior short segment internal fixation. Methods: a retrospective study was made on 80 cases of lumbar fractures treated by posterior short pedicle screw fixation and fusion from September 2013 to September 2016 in the Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, including 45 males and 35 females. The age was 32 to 55 years (mean 38 years); the follow-up period was 12 to 24 months, with an average of 18 months. The causes of injury were: falling injury in 30 cases, traffic accident injury in 35 cases, falling injury in 5 cases, smashing in 5 cases, and heavy object injury in 10 cases, the fracture segment was all single segment fracture, There were 32 cases of L _ 1 fracture and 25 cases of L _ 2 fracture. 18 cases of L _ 3 fracture were compared with that of L _ 3 fracture. 5 cases of L _ 4 fracture were divided into 6. 2 and L _ 5 fractures. According to AO classification, all of them were type A fractures, of which 49 cases were type A1 type 61.2A _ 2 type A _ 2 type and 26 cases were 32.5 and A3 type. All the patients had no spinal cord or nerve injury. According to the time of removal of internal fixation, they were divided into two groups: one year after operation, 40 cases were treated with internal fixation, and 40 cases were treated with internal fixation two years after operation. A total of 40 cases (80 cases) were examined with CT MRI before and after the removal of internal fixation. The anterior, middle and posterior edge height and wedge angle of the vertebral body were measured before and after the removal of internal fixation. The difference between the last measurement value and the preoperative measurement value of fracture was the corrected loss value, the CT and MRI images of lumbar vertebrae were observed before and after the removal of internal fixation, and the Weishaup imaging grading standard was used to evaluate the degeneracy of unfused segmental facet joints. Modic standard Pfirrmann classification system was used to evaluate the degenerative and intervertebral disc degeneration of fixed unfused segment endplate. SPSS17.0 software was used to analyze and compare the degenerative differences between the two groups of fixed unfused segments. Results the corrected loss values of vertebral wedge angle in group A and group B were 1.42 卤1.26 and 2.83 卤2.09, respectively. There was no significant difference between group A and group B after the removal of internal fixation and the preoperative AVHH MVHPVH and vertebral wedge angle. The remaining groups of data were compared, The difference was statistically significant between two groups of patients: P0.05. 2.The difference was statistically significant between the two groups before and after the removal of internal fixation. There was a significant difference between the two groups of patients with non-fused facet joint degeneration before and after the removal of internal fixation. There were significant differences between the two groups of patients without fusion before and after the removal of internal fixation. There was significant difference between the two groups in the degeneration of segmental intervertebral disc. There was significant difference between the two groups before and after the removal of internal fixation. There was significant difference between the two groups in the degeneration of the unfused segmental endplate. One year after short segment internal fixation for lumbar type A fractures, there were different degrees of degeneration in the fixation of unfused segments, as compared with that in the patients with 2 years of internal fixation. However, 1 year after operation and 2 years after the removal of internal fixation can effectively slow down the unfused segment degeneration. Conclusion: the treatment of lumbar type A fractures by posterior short segment internal fixation is satisfactory, and the removal of internal fixation one year after operation can effectively slow down the degeneration of unfused segments.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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