胸腰椎骨折长节段内固定术后脊柱旋转力线的临床观察

发布时间：2018-06-29 23:48

本文选题：胸腰椎骨折 + 长节段固定　；参考：《中国矫形外科杂志》2017年20期

【摘要】：[目的]观察胸腰椎骨折经后路长节段固定术后脊柱旋转力线的恢复情况,并探讨力线失衡的原因及其临床意义。[方法]分析本院2006年1月~2015年1月收治的45例胸腰椎骨折患者,AOSpine骨折分型为A3、A4、B型,其中男27例,女18例,年龄18~62岁,平均(33.02±10.41)岁,均接受后路长节段椎弓根螺钉内固定术。在正侧位X线片上测量患者手术前后棘突旋转距离(SPRD)及伤椎侧(后)凸Cobb角,统计固定节段长度、螺钉使用总数,计算单个椎体螺钉使用个数。根据术后脊柱旋转力线恢复情况,将患者分为力线良好组和力线失衡组。通过比较两组手术前后的测量指标,探讨力线失衡的原因及其临床意义。[结果]45例患者中,旋转力线良好者占32例(71.11%),旋转力线失衡者占13例(28.89%)。两组术前SPRD比较差异无统计学意义(P0.05);术后1周及末次随访时,失衡组患者SPRD明显大于良好组(P0.05)。两组固定节段长度和螺钉使用总数比较差异无统计学意义(P0.05);而单个椎体螺钉个数,失衡组(1.37±0.32)个,明显少于良好组的(1.71±0.29)个(P0.01)。[结论]后路胸腰椎长节段内固定能有效复位骨折椎体,恢复脊柱的生物力学特性;但部分患者术后存在脊柱旋转力线失衡的情况,与螺钉固定情况、手术技巧等方面密切相关,对术后脊柱稳定性有重要意义。
[Abstract]:[Objective] to observe the recovery of the spinal rotation force line after the posterior long segmental fixation of the thoracolumbar fracture, and to explore the causes and clinical significance of the imbalance of the force line. [Methods] to analyze 45 cases of thoracolumbar fractures treated in our hospital in January ~2015 January 2006. The AOSpine fractures were divided into A3, A4, B type, including 27 males and 18 females, the average age was 18~62 years old. (33.02 + 10.41) years of age, the posterior long segmental pedicle screw internal fixation was performed. The spinous process rotation distance (SPRD) and the lateral (posterior) convex Cobb angle before and after the operation were measured on the positive lateral X-ray film. The length of the fixed segment, the total number of screws used, the number of single vertebral studs used were calculated. The reasons and clinical significance of force line imbalance were discussed by comparing the measurement indexes of two groups before and after operation. [results among the patients with]45, 32 cases (71.11%) with good rotating force line (71.11%), 13 cases (28.89%) of rotating force line imbalance). There was no statistical difference between the two groups before operation (P0.05); 1 weeks after the operation. At the last follow-up, the SPRD in the unbalance group was significantly greater than that in the good group (P0.05). There was no significant difference in the length of the fixed segment and the total number of screws used in the two groups (P0.05), while the number of single vertebral screws, the imbalance group (1.37 + 0.32), was significantly less than that of the good group (1.71 + 0.29) (P0.01). [Conclusion] the posterior thoracolumbar spinal long segment internal fixation could be found. Effective reduction of fractured vertebral body and recovery of spinal biomechanical properties, but the imbalance of spinal rotation force in some patients after operation is closely related to screw fixation and surgical techniques, which is of great significance for postoperative spinal stability.
【作者单位】：南方医科大学南方医院脊柱骨科;南方医科大学南方医院创伤骨科;
【分类号】：R687.3

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