胸腰椎骨折内固定术后伤椎椎体中央高度恢复的影像学研究及临床意义

发布时间：2018-07-01 19:10

本文选题：胸腰椎骨折 + 短节段内固定　；参考：《中国脊柱脊髓杂志》2016年12期

【摘要】：目的 :探讨后路经伤椎与跨伤椎椎弓根螺钉内固定对胸腰椎骨折椎体中央高度恢复的影响及其临床意义。方法:回顾性分析我院2011年1月~2012年12月收治的胸腰椎骨折病例67例,其中男36例,女31例,年龄17~52岁,平均37.8±7.5岁。所有患者为T11~L2单椎体骨折(AO分型为A型),且无严重的神经脊髓症状(ASIA分级为D、E级)。均采用后路短节段椎弓根螺钉内固定术式,按固定方式不同分为经伤椎固定组(A组,n=37)、跨伤椎固定组(B组,n=30)。在PACS图像系统上测量X线侧位片伤椎椎体前缘高度(Ha)、椎体中央高度(Hm)、椎体后缘高度(Hp)及后凸Cobb角,计算Ha压缩率、Hm压缩率,比较术前、术后1周、末次随访时Ha压缩率、Hm压缩率及Cobb角,观察术后骨折椎体中央高度恢复的情况。结果:所有患者获得18~40个月的随访,平均随访时间26.5±8.9个月。无论经伤椎固定还是跨伤椎固定,术后Ha压缩率、Hm压缩率及Cobb角均较术前有显著减少(P0.05),其中A组患者Hm压缩率术前为(44.8±10.3)%,术后1周时为(31.6±7.1)%,末次随访时为(31.3±6.8)%。B组患者Hm压缩率术前为(38.6±8.3)%,术后1周时为(32.0±8.4)%,末次随访时为(31.7±8.6)%。A、B两组患者术后椎体中央高度均有约30%的压缩残留。结论 :经伤椎和跨伤椎椎弓根螺钉内固定治疗胸腰椎骨折均可促进骨折椎体前缘及中央高度的恢复,改善节段后凸角度,但术后伤椎椎体中央高度有明显压缩残留。
[Abstract]:Objective: to investigate the effect of posterior pedicle screw fixation on the recovery of vertebral body height in thoracolumbar fractures and its clinical significance. Methods: from January 2011 to December 2012, 67 cases of thoracolumbar fractures were retrospectively analyzed, including 36 males and 31 females, with an average age of 37.8 卤7.5 years. All patients were T11L2 single vertebral body fracture (AO type A) and no severe neurological and spinal cord symptoms (Asia grade was DNE grade). All patients were treated with posterior short segment pedicle screw fixation and were divided into two groups: group A (group A) and group B (group B). The anterior height (Ha), central height (H m), posterior edge height (HP) and kyphosis angle of vertebral body were measured on PACS imaging system. At the last follow-up, Ha compression ratio, H m compression rate and Cobb angle were observed to observe the recovery of fracture vertebral central height. Results: all the patients were followed up for 18 ~ 40 months with an average follow-up time of 26.5 卤8.9 months. Whether the injured vertebra is fixed or the cross-injured vertebra is fixed, The ratio of H _ m compression and Cobb angle in group A was (44.8 卤10.3) before operation, (31.6 卤7.1) at 1 week after operation, (31.3 卤6.8) in group B, (38.6 卤8.3) before operation, (32.0 卤8.4) at 1 week after operation, and (32.0 卤8.4) at 1 week after operation. At the follow-up time (31.7 卤8.6), there was about 30% compression residue in the central height of the vertebral body after operation in the two groups (31.7 卤8.6). Conclusion: the treatment of thoracolumbar fractures with transpedicular screw fixation can promote the recovery of anterior and central height of the fracture and improve the angle of segmental kyphosis, but the central height of the injured vertebral body is significantly compressed and residual after operation.
【作者单位】：南方医科大学南方医院脊柱骨科;
【分类号】：R687.3

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