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【摘要】 目的观察应用AF椎弓根钉系统复位固定加植骨融合治疗胸腰椎骨折脱位恢复的效应。方法 选取1997年7月至2006年6月外伤性胸腰段椎骨骨折患者153例。患者麻醉后常规植入AF椎弓根钉系统复位固定,如无神经损伤直接取自体髂骨或同种异体骨行后路植骨融合术。若有神经损伤,则先行椎板开窗探查,若骨折块已复位,同上行后路植骨融合。骨折块未复位或复位不理想,则需进一步减压;若经AF椎弓根钉系统复位固定后仍有明显压迫,则需通过咬除一侧椎弓根行骨折脊椎次环状减压术。对减压后缺损较大者,同时行椎间融合加椎体内植骨,对骨折脱位者从后路经椎管行椎间植骨融合术。结果 153例均未发生定位错误,无断钉、断棒及椎弓根钉松动、滑脱,无感染及医源性神经损伤等并发症。结论 AF椎弓根钉系统复位力强,可有效恢复伤椎椎体的高度并纠正成角畸形,提示在良好复位基础上的坚强固定与确实有效的植骨融合是取得理想效果的根本所在。
【关键词】 胸腰椎;损伤;治疗;研究
【Abstract】 Objective To observe the application of AF pedicle screw system fixation and bone graft fusion in the treatment of thoracolumbar fracture-dislocation recovery effect.Methods from July 1997 to June 2006 of traumatic thoracolumbar vertebral fractures in patients with 153 cases.Implantation in patients with AF after anesthesia conventional pedicle screw fixation system, such as the non-nerve damage directly from the iliac bone or the same kinds of allogeneic bone posterior fusion.If nerve damage, then the first exploratory laminectomy window, if the fracture block has been reset, ibid posterior fusion. fractures block is not reset or reset is not satisfactory, it would take to further reduce pressure; if by AF after pedicle screw fixation system, there is still significant pressure, you need to bite through the line of fracture of the spine pedicle addition to the side of the ring-decompression times. For the greater defects after decompression, while Bank of vertebral between fusion and vertebral body bone grafting, fracture and dislocation of persons from the right posterior spinal interbody fusion line.Results 153 patients were not locate the error occurred, no broken nails, broken rod and pedicle screw loosening, detachment, no infection, and iatrogenic complications such as nerve damage.Conclusion AF pedicle screw system reset strong, which can effectively restore vertebral body height of vertebral injury and to correct angular deformity, suggesting that in a good strong reset fixed on the basis of credible fusion is fundamental to achieve the desired results.
笔者在1997年7月至2006年6月在广州市太和镇医院外科与南方医科大学附属珠江医院骨科对153例外伤性胸腰段椎骨骨折患者进行AF椎弓根钉系统复位固定加植骨融合术治疗,收到良好效果,现报告如下。
1 资料与方法
1.1 一般资料 153例病例中,男98例,女53例;年龄16～68岁,平均36岁。受伤原因:高处坠落伤76例,交通伤64例,重物砸伤13例;骨折类型:屈曲压缩型89例、爆裂型46例,骨折脱位型14例,牵张型4例;CT检查:将椎管受阻程度按Wolter分类,指数为1者62例,指数为2者76例,指数为3者15例;植骨:后路椎板关节突融合107例,后路经椎管椎间植骨23例,椎间融合加椎体内植骨23例。
1.2 方法 手术步骤:患者在局部脊神经后支阻滞+强化或连续硬膜外麻醉下取俯卧位,显露伤椎及相邻上下各两节段脊椎的棘突、椎板、上下关节突,常规植入AF椎弓根系统复位固定,如无神经损伤则不必进行椎管减压,直接取自体髂骨或同种异体骨行后路植骨融合术。若有神经损伤,则先行椎板开窗探查,如骨折块已复位,如上行后路植骨融合。骨折块未复位或复位不理想,则需进一步减压,若骨折块小或压迫轻,可取出或用陷入法击入;若经AF椎弓根系统复位固定后仍有明显压迫。则需通过咬除一侧椎弓根行骨折脊椎次环状减压术。对减压后缺损较大者,同时行椎间融合加椎体内植骨,对骨折脱位者从后路经椎管行椎间植骨融合术。
影像学检查:常规摄胸腰段脊柱正侧位X线片,测量伤椎前缘高度的百分比(椎高百分比)及Cobb’s角(伤椎上一椎体上终板的连线与伤椎下一椎体下终板连线的交角)。椎高百分比(%)=伤椎高度×2/(上位椎板高度+下位椎板高度)×100%。
2 结果
本组153例术后X线复查均显示:内固定位置良好,椎体高度恢复。椎高百分比(%)从术前58.53%到术后当天97.82%;Cobb’s角从术前的17.39°到术后当天4.07°。
153例中除15例失访外其余138例均获随访,随访时间12～36个月,均未发生定位错误,无断钉、断棒及椎弓根钉松动、滑脱,无感染及医源性神经损伤等并发症,术后1年以后植骨处获得骨性融合。术后1年摄X片测量计算,椎高百分比(%)94.86%、Cobb’s角5.46°(x±s,n=138;P
