单纯内固定治疗骨块突入椎管的胸腰段骨折手术效果观察

发布时间：2018-06-14 10:14

本文选题：胸腰椎骨折 + 间接减压　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:探讨单纯椎弓根螺钉内固定间接减压治疗骨折块突入椎管30%-50%但无神经症状胸腰椎爆裂骨折的手术效果。方法:选取我院行椎弓根钉内固定间接减压治疗骨块突入椎管无神经损伤症状胸腰椎爆裂骨折患者72例。所有患者术前ASIA分级均为E级,术前均完善伤椎正侧位X线片、CT平扫重建、MRI等相关检查,X线观察椎体压缩性改变并测量其椎体压缩率,CT横截位片观察有骨折块突入椎管并测量椎管侵占率,MRI观察后纵韧带连续性是否存在。根据CT横截位片测量椎管内骨块侵占率分两组:A组(椎管侵占率0%-29%,n=40)。B组(椎管侵占率30%-50%,n=32)。所有病例均行单纯椎弓根螺钉内固定间接减压,通过随访分别记录两组术前、术后即刻、术后1月、术后3月、术后6月、术后12月的伤椎后凸Cobb角、椎体压缩率、椎管侵占率、VAS评分、ASIA(美国脊柱损伤协会)分级、并发症等指标,观察两组病例手术效果。结果:两组病例在年龄、性别、伤椎节段经统计学分析,P0.05,无明显统计学差异。所有患者均获得随访,平均随访时间12.71±1.16个月,72例患者术后均未出现神经症状。A组椎管侵占率由术前13.82±4.43%恢复至4.53±1.38%,P0.05;椎体压缩率由术前17.37±4.25%恢复至8.29±3.16%,P0.05;后凸Cobb角由12.17±2.43°恢复至6.39±1.57°P0.05。B组椎管侵占率由术前38.48±5.82%恢复至5.18±1.64%,P0.05;椎体压缩率由术前45.55±11.96%恢复至9.05±3.67%,P0.05;后凸Cobb角由22.71±5.35°矫正至7.29±2.42°P0.05。通过两组间t检验对比两组术后即刻、1月、3月、6月、12月Cobb角、椎体压缩率、椎管侵占率,P0.05,差异无统计学意义。秩和检验比较两组术前、术后VAS评分P0.05,差异无统计学意义。两组患者突入椎管骨折块复位满意,椎管形态术后即刻改善良好,随访过程中两组病例椎管形态均进一步改善,但均未见明显椎管重塑现象。两组术后并发症比较:术后1月时A组44.68%病例出现椎体高度较术后即刻丢失及后凸Cobb角增大现象,椎体高度平均丢失2.22%,后凸角平均增大1.28°,术后一月时B组46.75%出现椎体高度较术后即刻丢失及后凸Cobb较增大,椎体高度平均丢失3.14%,后凸角平均增大1.09°。继续随访至术后1年,未见椎体高度继续丢失及后凸角度继续增大。A组术后并发症中,出现切口延迟愈合3例,未见其他术后并发症。B组术后并发症出现切口延迟愈合3例,椎体蛋壳样改变1例,椎体真空征1例,两组比较,B组术后并发症发生率较高。结论:1.单纯内固定间接减压治疗骨折块突入椎管30%-50%无神经症状的胸腰椎爆裂骨折疗效满意。2.胸腰段骨折术后短期内易出现椎体高度少量丢失及伤椎后凸Cobb轻度增大。
[Abstract]:Objective: to investigate the effect of indirect decompression with pedicle screw fixation in the treatment of thoracolumbar burst fracture with 30-50% vertebral canal penetration without nerve symptoms. Methods: 72 cases of thoracolumbar burst fracture without nerve injury symptom were treated with indirect decompression with pedicle nail in our hospital. Before operation, Asia grade was grade E in all patients. Ct plain scan and MRI were all perfect before operation to observe the changes of vertebral compression and measure the compression rate of vertebral body. Ct transverse section film was used to observe the fracture mass into the spinal canal and measure the invasion rate of the spinal canal. Whether or not the continuity of the posterior longitudinal ligament exists. According to CT transection, the intraspinal invasion rate of bone mass was divided into two groups: group A (0 -29%) and group B (30% -50%). All cases were treated with indirect decompression with pedicle screw fixation. The Cobb angle and compression ratio of injured vertebral kyphosis were recorded before, immediately, 1 month, 3 months, 6 months after operation and 12 months after operation, respectively. The vertebral canal invasion rate (VAS) score, ASIA (American Spinal injury Association) classification, complications and other indicators were observed in the two groups. Results: there was no significant difference between the two groups in age, sex and injured vertebral segment (P 0.05). All patients were followed up. The average follow-up time was 12.71 卤1.16 months. The spinal canal invasion rate of group A recovered from 13.82 卤4.43% to 4.53 卤1.38 P0.05, the vertebral compression rate recovered from 17.37 卤4.25% to 8.29 卤3.16% P0.05, and the Cobb angle of kyphosis recovered from 12.17 卤2.43 掳to 6.39 卤1.57 掳P0.05.B after operation, the spinal canal invasion rate of group A recovered from 13.82 卤4.43% to 4.53 卤1.38%, from 17.37 卤4.25% to 8.29 卤3.16 掳P0.05, and the Cobb angle of kyphosis recovered from 12.17 卤2.43 掳to 6.39 卤1.57 掳P0.05.B 38.48 卤5.82% recovered to 5.18 卤1.64% P 0.05, vertebral compression rate recovered from 45.55 卤11.96% to 9.05 卤3.67 P 0.05, kyphosis Cobb angle corrected from 22.71 卤5.35 掳to 7.29 卤2.42 掳P 0.05. There was no significant difference in Cobb angle, vertebral compression ratio and spinal canal invasion rate between the two groups immediately, 1 month, 3 months, 6 months and 12 months after operation by t test. There was no significant difference in VAS score between the two groups before and after operation by rank sum test (P 0.05). The two groups of patients were satisfied with the reduction of the vertebral canal fracture and the morphology of the vertebral canal was improved immediately after the operation. During the follow-up the morphology of the vertebral canal was further improved in both groups but there was no obvious phenomenon of vertebral canal remodeling. Comparison of postoperative complications between the two groups: 44.68% of the patients in group A had lost vertebral body height and increased Cobb angle of kyphosis at one month after operation. The average loss of vertebral height and kyphoid angle were 2.222.22 and 1.28 掳respectively. At one month after operation, 46.75% of the patients in group B had higher height of vertebral body than that of immediate loss and Cobb of kyphosis. The average loss of height of vertebral body and kyphoid angle were 3.14 and 1.09 掳respectively. In group A, there were 3 cases of delayed healing of incision and 3 cases of delayed healing of incision in group B. there were 3 cases of delayed healing of incision in group B and 3 cases of delayed healing of incision in group A. The incidence of postoperative complications in group B was higher than that in group B. Conclusion 1. Treatment of 30-50% thoracolumbar burst fracture without neurological symptoms by indirect decompression with internal fixation was satisfactory. After thoracolumbar fracture, a little loss of vertebral height and a slight increase of Cobb in injured vertebral kyphosis occurred in short term.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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