单节段椎弓根螺钉固定治疗胸腰椎骨折的临床观察

2012-10-16施林军倪东亮

浙江医学教育 2012年6期

关键词：手术

施林军，曹扬，赵巍，林平，倪东亮

(金华市中心医院，浙江金华 321000)

·基础与临床研究·

单节段椎弓根螺钉固定治疗胸腰椎骨折的临床观察

施林军，曹扬，赵巍，林平，倪东亮

(金华市中心医院，浙江金华 321000)

目的：探讨经伤椎置钉单节段椎弓根螺钉固定结合后外侧植骨治疗胸腰椎骨折的临床疗效。方法2009年1月至2010年12月，对l4例胸腰椎骨折采用后路经伤椎置钉单节段椎弓根螺钉固定结合后外侧植骨融合治疗，比较手术前后伤椎椎体前缘高度及Gardner角变化，并观察椎体复位丢失及内固定物情况。结果平均手术时间83min(52～125min)，出血量120mL(50～350mL)，无医源性神经损伤；术后所有病例均获得随访，平均随访16.8个月(12～24个月)，术后伤椎椎体前缘高度及Gardner角较术前均明显改善，未见内固定松动、断裂、脱出，所有病例均获得骨性融合。结论单节段椎弓根螺钉固定治疗胸腰椎骨折手术创伤小，临床疗效令人满意，但需严格掌握手术适应证及手术技巧。

椎弓根螺钉内固定；单节段固定；胸腰椎骨折；脊柱创伤

Abstract：[Objective] To evaluate the clinical outcome of thoracolumbar spine fracture treatmented with posterior monosegmental transpedicular fixation at the injured vertevrae. [Method] From January 2009 to December 2010, 14 cases of thoracolumbar spine fracture were treated by the surgical procedure of posterior monosegmental injured vertebral pedicle internal fixation and injured vertebra bone grafting fusion. The status of internal fixation material was followed up and the vertebral height and kyphosis angle were compared before and after the surgery. [Result] The mean operation time, average bleeding volume during operation, was 83 min (52～125min), 120ml (50～350m1), respectively. There was no iatrogenic nerve injure in all cases. All patients obtained the follow up and the average time was 16.8 months (12～24 moths). No internal fixation material breaking, loose and dislocation were found after operation. Bony union was observed in all cases. Postoperation vertebral height and segmental kyphosis angle different chips were statistically significant. [Conclusion] The posterior monosegmental injured vertebral internal fixation is one of effective method for treating thoracolumbar spine fracture. Strict indication and surgical skill is the key to this procedure.

Keywords：thoracolumbar spine fracture；vertebral pedicle screw internal fixation；monosegmental fixation；Spinal trauma

后路短节段椎弓根螺钉固定是目前国内外治疗胸腰椎骨折的最常见术式之一[1]，但跨节段固定所带来的椎体高度丢失、内固定断裂及临近节段退变加重等并发症已越来越受到人们的重视[2]。因此，如何既能减少固定节段又能避免内固定失效成为近年热点研究之一。我科自2009年1月至2010年12月采用单节段经伤椎椎弓根螺钉固定结合后外侧植骨融合治疗胸腰椎骨折14例，报告如下。