摘要
目的评价短节段非融合椎弓根螺钉固定治疗不稳定性胸腰椎爆裂骨折的临床效果。方法 19例不稳定性胸腰椎爆裂骨折患者均接受短节段非融合椎弓根螺钉固定治疗,分别于术前、术后12个月取出内固定物之前及取出内固定物后6个月对患者进行临床及影像学评估,观察椎管内占位情况、椎体高度、临床效果及并发症等。结果本组病例的平均手术时间为(93.4±18.3)min;平均术中失血量为(92.1±20.2)mL。术前、术后12个月取出内固定物之前及取出内固定物后6个月患者椎管内占位率分别为(55.4±3.8)%、(35.6±4.1)%、(35.4±3.9)%;术后12个月内固定物取出前及内固定物取出后6个月时患者椎管内占位率显著高于术前,差异有统计学意义(P<0.05);但术后12个月内固定物取出前与内固定物取出后6个月时患者椎管内占位率比较,差异无统计学意义(P>0.05)。术前、术后12个月取出内固定物之前及取出内固定物后6个月患者伤椎椎体高度丢失率分别为(45.3±3.4)%、(16.9±2.9)%、(18.1±3.1)%;术后12个月内固定物取出前及内固定物取出后6个月时患者伤椎椎体高度丢失率显著低于术前,差异有统计学意义(P<0.05);但术后12个月内固定物取出前与内固定物取出后6个月时患者伤椎椎体高度丢失率比较,差异无统计学意义(P>0.05)。术前、术后12个月取出内固定物之前及取出内固定物后6个月患者VAS疼痛评分分别为8.2±1.8、2.2±1.3、2.1±1.1;术后12个月内固定物取出前及内固定物取出后6个月时患者视觉模拟量表(VAS)疼痛评分显著低于术前,差异有统计学意义(P<0.05);但术后12个月内固定物取出前与内固定物取出后6个月时患者VAS疼痛评分比较,差异无统计学意义(P>0.05)。按Macnab评价标准,19例患者中,优15例,良3例,可1例,优良率为94.7%。结论短节段非融合椎弓根螺钉固定治疗无神经损伤症状的不稳定性胸腰椎爆裂骨折年轻患者安全、有效,且内固定物取出后伤椎的椎体高度及受累节段的椎体容积改善水平能够继续保持。
Objective To evaluate the clinical effect of short segment vertebral pedicle screw fixation of non-fusion for treating unstable thoracolumbar burst fracture. Methods Nineteen patients with unstable thoracolumbar burst fracture were treated with short segment vertebral pedicle screw fixation of non-fusion. The intraspinal occupying, vertebral height, clinical effect and complications were observed by clinical and radiological evaluation before operation, before internal fixity removal and twelve months after operation, six months after internal fixity removal. Results The average operation time was （93.4± 18.3 ） minutes ,the average intraoperative blood loss was （92. 1 ± 20.2） mL. The intraspinal occupying rate was （ 55.4 ± 3.8 ） % , （ 35.6 ± 4.1 ） % and （ 35.4 ± 3.9 ） % respectively before operation, before internal fixity removal（ twelve months after operation） and six months after internal fixity removal. The intraspinal occupying rate before internal fixity removal （twelve months after operation） and six months after internal fixity removal was significantly higher than that before operation（ P 〈 0. 05）. There was no significant difference in the intraspinal occupying rate before internal fixity removal（ twelve months after operation） and six months after internal fixity removal （P 〉 0.05 ）. The vertebral height loss rate was （45.3 ± 3.4 ）%, （ 16.9± 2. 9） % and （ 18.1 ± 3.1 ） % respectively before operation, before internal fixity removal （ twelve months after operation） and six months after internal fixity removal. The vertebral height loss rate before internal fixity removal（ twelve months after operation） and six months after internal fixity removal was significantly lower than that before operation （P 〈 0.05 ）. There was no significant difference in the vertebral height loss rate before internal fixity removal（ twelve months after operation） and six months after internal fixity removal（ P 〉 0.05 ）. The visal analogue scale（VAS） pain score was 8.2 ± 1.8,2.2 ± 1.3 and 2.1 ± 1.1 respectively before operation,before internal fixity removal（ twelve months after operation） and six months after in- ternal fixity removal. The VAS pain score before internal fixity removal（ twelve months after operation） and six months after internal fixity removal was significantly lower than that before operation （ P 〈 0.05 ）. There was no significant difference in the VAS pain score before internal fixity removal（ twelve months after operation） and six months after internal fixity removal（ P 〉 0.05 ）. According to Macnab evaluation standard,among 19 patients,excellent in 15 cases, good in 3 cases, fair in 1 case, the excellent and good rate was 94.7%. Conclusion Short segment vertebral pedicle screw fixation of non-fusion in the treatment of young patients with unstable thoracolumbar burst fracture without nerve injury symptom is safe and effective, and can keep the vertebral height and vertebral volume.
出处
《新乡医学院学报》
CAS
2014年第3期226-229,共4页
Journal of Xinxiang Medical University
关键词
胸腰椎爆裂性骨折
椎弓根
内固定
thoracolumbar burst fracture
vertebral pedicle
internal fixation
