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单侧伤椎置钉联合短节段椎弓根螺钉内固定治疗轻中度不稳定性胸腰椎骨折

Unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability

摘要:

目的 探讨经后路单侧伤椎置钉联合短节段椎弓根螺钉内固定治疗轻中度不稳定的胸腰椎骨折的手术治疗效果.方法 回顾性分析2008年1月至2009年12月收治的26例载荷分享评分(LSC)为4~6分、单节段胸腰椎骨折并行单侧伤椎置钉联合短节段椎弓根螺钉内固定的患者临床资料.其中男性16例,女性10例,年龄39 ~ 60岁,平均47.3岁.LSC评分,4分2例,5分14例,6分10例.患者神经功能评定参照Frankel分级,C级2例,D级3例,E级21例.依据患者伤椎前缘高度比、矢状面Cobb角、神经功能情况、内固定失败情况、视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)进行疗效评价.结果 患者随访时间13 ~ 26个月,平均18.6个月,无内固定失败发生.术前有神经功能不完全损害的5例患者中4例获得完全恢复,1例由术前C级部分恢复到D级.患者伤椎前缘高度由术前平均57.0%±6.3%恢复到术后94.6%±1.9%,末次随访时为93.1%±1.7%,差异有统计学意义(F=455.276,P<0.05);矢状面Cobb角由术前平均15.6°±4.7°恢复到术后1.1°±4.6°,末次随访维持在2.6°±5.2°,差异有统计学意义(F=34.623,P<0.05).术后不同时间点之间比较差异均无统计学意义(P>0.05).末次随访VAS平均为1.0±0.7,ODI为17.0±5.9.结论 对于轻中度不稳定的胸腰椎骨折患者进行单侧伤椎置钉联合短节段椎弓根螺钉内固定治疗安全有效.

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abstracts:

Objective To evaluate the efficacy of unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability. Methods Twenty-six patients with single segment thoracolumbar fracture received unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw from January 2008 to December 2009. There were 16 patients were male and 10 were female with an average age of 47.3 years (range from 39 to 60 years).Fracture severity score was constructed by using the load-sharing classification (4 points for 2 cases,5 points for 14 cases,6 points for 10 cases).By Frankel assessment system,2 cases were in grade C,3 in grade D,21 in grade E. The assessment included anterior vertebral body height,the sagittal Cobb angle,the restoration of nervous function,visual analogue score (VAS) and Oswestry disability index (ODI).Results The follow-up after the surgery was 13-26 months,with an average of 18.6 months.There were no fixation failure,defined as implant failure or ≥ 10°correction loss.The neurological status of 4 patients,who had an associated neurologic deficit preoperatively,was completely recovered. The Frankel grade of another case was re-rated D from the original C.The mean anterior vertebral body height increased from 57.0% ± 6.3% before the surgery to 93.1% ± 1.7% at the last follow-up( F =455.276,P < 0.05 ).The sagittal Cobb angle decreased from 15.6° ± 4.7° before the surgery to 2.6° ± 5.2° at the last follow-up ( F =34.623,P <0.05).VAS and ODI were 1.0 ± 0.7 and 17.0 ± 5.9 at the last follow-up.Conclusion Unilateral pedicle screw fixation through the pedicle of fractured vertebra combined with the short segment of pedicle screw is effective for thoraclumbar fracture with mild to moderate instability.

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作者: 曾至立 [1] 程黎明 [1] 钱列 [1] 贾永伟 [1] 于研 [1] 王建杰 [1]
第一作者: 曾至立
期刊: 《中华外科杂志》2012年50卷3期 234-237页 MEDLINEISTICPKUCSCD
分类号: R274.1
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2012.03.012
发布时间: 2012-04-20
基金项目:
上海市科委重点支撑项目 国家自然科学基金
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