| 曾忠友,籍剑飞,严卫锋,吴鹏,张建乔,宋永兴,韩建福,宋国浩.270°或360°椎管减压并一期椎弓根螺钉固定及椎体重建治疗严重胸腰椎骨折的疗效对比[J].脊柱外科杂志,2016,14(6):345-351. |
270°或360°椎管减压并一期椎弓根螺钉固定及椎体重建治疗严重胸腰椎骨折的疗效对比  点此下载全文 (Fulltext) |
| 曾忠友 籍剑飞 严卫锋 吴鹏 张建乔 宋永兴 韩建福 宋国浩 |
| 武警部队骨科医学中心, 武警浙江省总队嘉兴医院骨二科, 浙江 314000 |
| 基金项目：浙江省嘉兴市科技计划项目（2010AY1056） |
| DOI：10.3969/j.issn.1672-2957.2016.06.006 |
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| 摘要： |
| 目的 对比椎管减压方式（270°和360°）并一期后路椎弓根螺钉固定、脊椎前中柱重建治疗严重胸腰椎骨折的优缺点。方法 选择2009年1月-2011年12月分别采用270°和360°椎管减压并同时行椎弓根螺钉固定和脊椎前中柱重建治疗且资料完整的36例严重胸腰椎骨折病例，按美国脊髓损伤协会（ASIA）分级标准：A级2例，B级5例，C级17例，D级12例。接受270°椎管减压组（A组）17例，360°椎管减压组（B组）19例。观察并对比两组病例的临床和影像结果。结果 所有患者均获得随访，随访14~48个月，平均28.5个月。两组病例手术时间、术中出血量、术后引流量及术中和术后输异体血量比较，差异均有统计学意义（P<0.05），A组优于B组。随访期间未发现内固定松动或断裂现象。两组病例Cobb角、椎体前缘高度及椎管占位均较术前改善，差异有统计学意义（P<0.05）；组间在术后Cobb角矫正度和椎体前缘高度恢复方面，相比差异无统计学意义（P>0.05），但在椎管占位的恢复方面差异有统计学意义（P<0.05），B组优于A组。两组病例的钛网植骨均获得骨性融合。末次随访时，两组病例中除ASIA分级A级患者外脊髓功能均有不同程度的恢复，在脊髓功能恢复方面两组比较差异无统计学意义（P>0.05）。结论 对于严重胸腰椎骨折的一期后路固定、椎管减压和脊椎前中柱重建术，270°和360°椎管减压各有优缺点，采用360°椎管减压需慎重，而270°椎管减压有待进一步改进。 |
| 关键词：胸椎 腰椎 脊柱骨折 骨折固定术,内 减压术,外科 |
| 270° vs. 360° spinal canal decompression with one-stage pedicle screw fixation and vertebral reconstruction for severe thoracolumbar fractures Fulltext |
| ZENG Zhong-you JI Jian-fei YAN Wei-feng WU Peng ZHANG Jian-qiao SONG Yong-xing HAN Jian-fu SONG Guo-hao |
| Second Department of Orthopaedics, Hospital of Zhejiang General Corps of Chinese People's Armed Police Forces, Jiaxing 314000, Zhejiang, China |
| Fund Project: |
| Abstract: |
| Objective To compare the advantages and disadvantages between 270° and 360° spinal canal decompression combined with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column for treatment of severe thoracolumbar fractures. Methods Totally 36 patients with severe thoracolumbar fractures who underwent 270° or 360° spinal canal decompression(SCD) combined with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column respectively between January 2009 to December 2011 were included in the study. The spinal injury grade included ASIA A in 2 cases,B in 5,C in 17,and D in 12. There were 17 patients in 270° SCD group(group A) and 19 in 360° SCD group(group B). Clinical and imaging outcomes were compared between the 2 groups. Results All the patients were followed up for 14-48 months,mean 28.5 months. The operation time,intraoperative blood loss,volume of postoperative wound drainage, intraoperative and postoperative allogeneic blood transfusion in group A were significantly superior to those in group B(P<0.05). No loosening and breakage of implants were found during the follow up period. There were significant intragroup differences in the recovery of height of injured vertebral anterior edge and spinal canal compromise,the correction of Cobb's angle of the spine between pre-operation and post-operation(P<0.05),but no significant differences were observed in these indices between final follow-up and immediately post-operation. There were no significant differences in the recovery of height of vertebral anterior edge and the correction of Cobb's angle between the 2 groups,but the recovery of spinal canal compromise in group B was significantly superior to that in group A(P<0.05). All the patients obtained bone fusion with titanium mesh. At the final follow-up, neurological function in all patients except the 2 ASIA A grade patients was found to have recovered to different extents. There were no significant differences in recovery of neurological function between the 2 groups. Conclusion 270° and 360° SCD combined with one-stage posterior fixation and reconstruction of anterior and middle vertebral column for treatment of severe thoracolumbar fractures have its own advantages and disadvantages respectively. 360° SCD should be used with caution,and 270° SCD should be further improved. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Spinal fractures Fracture fixation, internal Decompression, surgical |
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