单侧椎板开窗植骨内固定术治疗胸腰椎爆裂骨折的疗效评价
[Abstract]:Objective: to investigate the effect of unilateral laminectomy decompression and bone grafting combined with short segment internal fixation in the treatment of thoracolumbar burst fracture. The relationship between burst type of injured vertebra, load sharing classification (LSC) score, damage degree of adjacent anatomical structure, fixation and bone grafting, and the healing of injured vertebrae were analyzed. The purpose of this study was to provide a reference index for the choice of surgical methods and follow-up of thoracolumbar burst fracture. Methods: 38 cases of thoracolumbar burst fracture (Denis A / B type) were included in this study. There were 30 males and 8 females aged 41.21 卤12.37 years old. The injured vertebrae included T12 (4 cases), L1 (18 cases), L2 (9 cases) and L3 (7 cases). The average follow-up time was (27.26 卤8.47) months. The LSC score of burst type of injured vertebra, the degree of destruction of anatomic structure of adjacent spinal canal and the influence of bone grafting on the healing of injured vertebra were analyzed. Spinal canal patency rate (伪), anterior height ratio (H), anterior and posterior height ratio (BI), sagittal cobb angle (CA), vertebral wedge angle (VWA) 2) were evaluated based on imics platform. To analyze the central or peripheral nerve function (Asia grade), complications and so on. Results: there were significant differences in the imaging parameters (1: 1) LSC score: 5 ~ 8 (mean 7.06 卤0.87) before and after operation (56.66 卤13.07), (92.47 卤3.80)% (p0.05), anterior height ratio, anterior and posterior height ratio (Cobb angle), wedge angle (P < 0.05), spinal canal patency rate (56.66 卤13.07), anterior height ratio (P 0.05), anterior and posterior height ratio (P < 0.05), vertebral wedge angle (P < 0.05). The ratio of anterior height of injured vertebrae, the ratio of anterior height of injured vertebra to Cobb angle, the ratio of anterior and posterior height of injured vertebrae to Cobb angle, and the angle of wedge change of injured vertebra were not significantly different between preoperative and postoperative follow-up (p0.05) and 3 months after operation (p0.05), the ratio of anterior height of injured vertebrae to that of anterior edge of injured vertebra was not significantly different (p0.05). There were significant differences in the anterior and posterior edge height of the injured vertebrae (p0.05), but there was no significant difference in the angle of vertebral wedge change (p0.05) in the 3 months and the last follow-up after the operation, the ratio of the anterior height of the injured vertebra to that of the anterior edge of the injured vertebra, the ratio of the anterior and posterior edge height of the injured vertebra. There was no statistical difference (p 0.05) in wedge angle of injured vertebrae (p 0.05), and there was significant difference in Cobb angle (p 0.05). Three dimensional reconstruction of injured vertebrae: 1 case, bone graft volume 3477.76 mm 3, and 8 cases at the last follow-up, the CT value of the upper layer of the same wound vertebra healing area was generally lower than that of the lower layer. The recovery of nerve injury, except for one patient with grade A, was improved at or above the first level. No cerebrospinal fluid leakage, aggravated nerve injury and 3 cases of sagittal Cobb angle loss were found in 1 case. Conclusion: the treatment of thoracolumbar burst fracture (Denis A / B type) with decompression of posterior laminectomy, anterior wall vertebroplasty and short segment internal fixation is effective. This procedure can be used as a reference for selection, and 3D reconstruction based on MIMICS platform can objectively evaluate the imaging outcome of traumatic vertebral fracture.
【学位授予单位】:遵义医学院
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R687.3
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