Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture_West China Medical Journal

Authors：

SONG Jingang ¹ , MIAO Yan ² , CUI Yikun ¹ , YIN Zhenyu ¹ , HUANG Haifeng ¹ , ZHAO Bing ¹

1. Department of Orthopedics, Central Hospital of Mianyang City, Mianyang, Sichuan 621000, P. R. China; 2. Department of Orthopedics, People’s Hospital of Mianyang City, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

Keywords：

胸腰椎骨折; 椎弓根釘; 傷椎; 內固定

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目的　探討經傷椎椎弓根螺釘內固定治療胸腰椎骨折的臨床療效。方法　2008年5月－2010年12月，選擇38例胸腰椎骨折患者，采用椎弓根螺釘固定傷椎及相鄰上下椎體。其中男28例，女10例；年齡21～65歲，平均36.5歲。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受傷至手術時間3～7 d，平均4.5 d。對患者手術前后椎體高度、矢狀面后凸Cobb角、神經功能Frankel分級變化等指標進行測量并隨訪。結果　術后患者切口均Ⅰ期愈合。38例獲隨訪12～18個月，平均15個月。骨折均獲得骨性融合，無釘棒斷裂、無死亡或神經損傷加重患者。術后神經功能Frankel分級較術前有明顯改善（P＜0.05）。術后X線片復查示傷椎高度恢復達90%以上，外形正常；CT復查示椎管內有效矢狀徑恢復滿意，椎管前方無明顯骨性壓迫，傷椎椎體骨愈合良好。術后1、12個月時傷椎前、后緣高度及后凸Cobb角均較術前顯著改善（P＜0.05）；術后12個月隨訪椎體高度無丟失。結論　經傷椎椎弓根釘復位、減壓、內固定治療胸腰椎骨折具有創傷小、固定節段少、脊柱穩定性好、能有效矯正及預防脊柱后凸畸形等優點。

Citation： SONG Jingang,MIAO Yan,CUI Yikun,YIN Zhenyu,HUANG Haifeng,ZHAO Bing. Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture. West China Medical Journal, 2012, 27(8): 1146-1149. doi: Copy

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3.	殷軍, 李愛民, 王寧, 等. 短節段加傷椎固定結合硫酸鈣填充治療胸腰椎爆裂骨折[J] . 中國脊柱脊髓雜志, 2011 , 21 (7) :561-565.
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7.	Liu S, Li H, Liang C, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(1): 38-44．.
8.	Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J]. J Spinal Disord, 1994, 7(5):402-407.
9.	宋無進, 蔡錦方．胸腰段骨折不同固定方式的有限元分析[J].中國組織工程研究與臨床康復, 2009, 13(52): 10269-10273．.
10.	Whang PG, Vaccaro AR, PoeIstra KA, et al. The influence of Fracture mechanism and morpholoqy on the reliability and validity of two novel thoracolumbar injury classification systems[J].Spine (Phila Pa 1976), 2007, 32(7): 791-795．.
11.	呂夫新, 黃勇, 張強, 等.胸腰椎骨折傷椎椎弓根內固定生物力學研究與臨床應用[J]. 脊柱外科雜志, 2008, 6(4): 229-234.
12.	王洪偉, 李長青, 周躍, 等. 脊柱骨折經傷椎椎弓根置釘附加橫連短節段固定的穩定性測試[J]. 中國脊柱脊髓雜志, 2010, 20(9): 745-749.
13.	王洪偉, 李長青, 周躍, 等. 傷椎置釘技術治療胸腰椎骨折的生物力學及臨床隨訪研究[J].中國脊柱脊髓雜志, 2011, 19(16): 1356-1360.
14.	Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(6): 417-421.
15.	黃海多, 楊有猛, 盧家靈.椎弓根螺釘內固定間接減壓治療胸腰椎骨折療效觀察[J].臨床骨科雜志, 2008, 11(5): 446-449.
16.	劉鵬, 李遠安, 趙建華, 等.后路短節段固定融合術選擇性治療胸腰段爆裂性骨折[J]. 創傷外科雜志, 2008, 10(4): 333-336.
17.	王文孝, 丁全峰, 張曉琴. 胸腰椎骨折椎弓根釘固定術后矯正度丟失的原因分析[J]. 中國脊柱脊髓雜志, 2002, 12(3): 186.
18.	Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures[J]. Spine (Phila Pa 1976), 2005, 30(3): E73-79.

1. 　Bailey CS, Dvorak MF, Thomas KC, et al. Companson of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial[J]. J Neurosurg Spine, 2009: 11(3): 295-303．.
2. 　Ragel BT, Allred CD, Brevard S, et al. Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices[J]. Spine (Phila Pa 1976), 2009, 34(22): 2400-2455．.
3. 　殷軍, 李愛民, 王寧, 等. 短節段加傷椎固定結合硫酸鈣填充治療胸腰椎爆裂骨折[J] . 中國脊柱脊髓雜志, 2011 , 21 (7) :561-565.
4. 　Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation[J]．J Spinal Disord Tech, 2010, 23(5): 293-301．.
5. 　Wei FX, Liu SY, Liang CX, et al. Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short- segment instrumentation[J]. Spine (Phila Pa 1976), 2010, 35(15): 714-720．.
6. 　Park WM, Park YS, Kim K, et al. Biomechanical companson of insIrumentation techniaues in treatment Of thoracolumbar burst fraclures: a finite elementanalysis[J]. J Orthop Sci, 2009, 14(4): 443-449．.
7. 　Liu S, Li H, Liang C, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(1): 38-44．.
8. 　Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J]. J Spinal Disord, 1994, 7(5):402-407.
9. 　宋無進, 蔡錦方．胸腰段骨折不同固定方式的有限元分析[J].中國組織工程研究與臨床康復, 2009, 13(52): 10269-10273．.
10. 　Whang PG, Vaccaro AR, PoeIstra KA, et al. The influence of Fracture mechanism and morpholoqy on the reliability and validity of two novel thoracolumbar injury classification systems[J].Spine (Phila Pa 1976), 2007, 32(7): 791-795．.
11. 　呂夫新, 黃勇, 張強, 等.胸腰椎骨折傷椎椎弓根內固定生物力學研究與臨床應用[J]. 脊柱外科雜志, 2008, 6(4): 229-234.
12. 　王洪偉, 李長青, 周躍, 等. 脊柱骨折經傷椎椎弓根置釘附加橫連短節段固定的穩定性測試[J]. 中國脊柱脊髓雜志, 2010, 20(9): 745-749.
13. 　王洪偉, 李長青, 周躍, 等. 傷椎置釘技術治療胸腰椎骨折的生物力學及臨床隨訪研究[J].中國脊柱脊髓雜志, 2011, 19(16): 1356-1360.
14. 　Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(6): 417-421.
15. 　黃海多, 楊有猛, 盧家靈.椎弓根螺釘內固定間接減壓治療胸腰椎骨折療效觀察[J].臨床骨科雜志, 2008, 11(5): 446-449.
16. 　劉鵬, 李遠安, 趙建華, 等.后路短節段固定融合術選擇性治療胸腰段爆裂性骨折[J]. 創傷外科雜志, 2008, 10(4): 333-336.
17. 　王文孝, 丁全峰, 張曉琴. 胸腰椎骨折椎弓根釘固定術后矯正度丟失的原因分析[J]. 中國脊柱脊髓雜志, 2002, 12(3): 186.
18. 　Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures[J]. Spine (Phila Pa 1976), 2005, 30(3): E73-79.

West China Medical Journal

Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture

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