| 伤椎置钉与撑开复位在术中的先后次序对治疗高椎管侵占率的胸腰椎骨折的影响 |
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Received:July 07, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王越 |
WANG Yue |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
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| 李良生 |
LI Liang-sheng |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
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| 陈恒梅 |
CHEN Heng-mei |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
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| 郑海伦 |
ZHENG Hai-lun |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
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| 陈世杰 |
CHEN Shi-jie |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
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| 陈建泉 |
CHEN Jian-quan |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
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| 王春 |
WANG Chun |
福建医科大学附属闽东医院脊柱外科, 福建 宁德 355000 |
Department of Spinal Surgery, Mindong Hospital Affiliated to Fujian Medical University, Ningde 355000, Fujian, China |
wangchunwc0215@163.com |
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| 期刊信息：《中国骨伤》2025年25卷，第5期，第508-516页 |
| DOI：10.12200/j.issn.1003-0034.20240207 |
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目的:探讨应用经伤椎置钉的短节段经皮椎弓根钉内固定治疗高椎管侵占率的胸腰椎爆裂性骨折时伤椎置钉与撑开复位的先后次序对手术疗效的影响。
方法:回顾性分析2016年1月至2022年1月收治的高椎管侵占率的胸腰椎爆裂性骨折(椎管侵占率>40%、后纵韧带完整、椎体后缘无翻转骨块)且无合并脊髓损伤的38例患者,所有患者采用短节段经皮椎弓根钉内固定,术中运用先钉棒撑开复位再伤椎置钉后二次再撑开复位(先复位组)18例,女8例,男10例,年龄46.5(38.5,50.0)岁;先伤椎置钉后直接撑开复位(先置钉组)20例,女10例,男10例,年龄46.0(35.8,50.8)岁。通过测量两组伤椎前缘高度比值、伤椎后凸Cobb角、椎管侵占率、椎管侵占改善率等指标进行对比评价。
结果:两组均获得1年以上有效随访,未见脊髓及神经根损伤、螺钉松动、钉棒断裂等并发症。两组术后伤椎前缘高度比值、伤椎后凸Cobb角均较术前明显改善,差异有统计学意义(P<0.05);术后3个月、1年的改善程度均较前一个时间点有所丢失,差异有统计学意义(P<0.05)。两组术后1 d及术后1年的椎管侵占率较术前均有改善,差异有统计学意义(P<0.05);先复位组术后椎管容积改善程度明显优于先置钉组,差异有统计学意义(P<0.01)。
结论:在治疗高椎管侵占率的胸腰椎骨折患者中,采用先撑开复位再进行置钉而后再次序贯撑开的短节段经皮椎弓根钉内固定术可更有效地复位椎管内的骨性占位,实现更好的间接减压效果。 |
| [关键词]:胸腰椎骨折 高椎管侵占率 复位 经皮椎弓根钉 内固定 |
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| Effect of the sequence of intermediate instrumentation and distraction-reduction of the injured vertebra on the treatment of thoracolumbar burst fractures with high rate of spinal canal encroachment |
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Abstract:
Objective To investigate the effect of the sequence of intermediate instrumentation and distraction-reduction of the injured vertebra on the surgical efficacy of short-segment percutaneous pedicle screw fixation for thoracolumbar burst fractures with high rate of spinal canal encroachment.
Methods From January 2016 to January 2022,38 patients with thoracolumbar burst fractures with high rate of spinal canal encroachment (spinal canal encroachment rate >40%,complete posterior longitudinal ligament,no flipping bone block in the posterior marginal of the vertebra) without spinal cord injury who were were treated with short-segment percutaneous pedicle screw fixation were retrospectively analyzed. During the operation,18 cases were used distraction-reduction first and then intermediate instrumentation on injured vertebral and sequential distraction-reduction again(the distraction-reduction first group) including 8 females and 10 males with a mean age of 46.5 (38.5,50.0) years old,and the other 20 cases were used intermediate instrumentation on injured vertebral first and then direct distraction-reduction(the intermediate instrumentation first group) including 10 males and 10 females with a mean age of 46.0 (35.8, 50.8) years. The anterior height ratio of the injured vertebra,local Cobb's angle of the injured vertebrae,the spinal canal encroachment rate,and the improvement rate of spinal canal encroachment were compared and evaluated.
Results All patients were followed up for more than 1 year,and no complications such as spinal cord and root injury,screw loosening and screw rod fracture were found. The anterior height ratio of the injured vertebra,local Cobb' angle of the injured vertebra in the two groups were significantly improved compared with preoperative data(P<0.05),and those at 3 months and 1 year after operation was lost compared with that at the previous time point(P<0.05). Although the spinal canal encroachment rate of the two groups 1 day and 1 year after operation was improved compared with that before operation(P<0.05),the improvement of spinal canal volume in the distraction-reduction first group was significantly better than that in the intermediate instrumentation first group (P<0.01).
Conclusion In the treatment of patients with thoracolumbar fractures with high rate of spinal canal encroachment,short-segment percutaneous pedicle screw internal fixation with distraction-reduction first and then intermediate instrumentation and sequential distraction-reduction again can more effectively reduce the bony encroachment in the spinal canal and achieve indirect decompression effect better. |
| KEYWORDS:Thoracolumbar fractures High rate of spinal canal encroachment Reduction Percutaneous pedicle screw Internal fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王越,李良生,陈恒梅,郑海伦,陈世杰,陈建泉,王春.伤椎置钉与撑开复位在术中的先后次序对治疗高椎管侵占率的胸腰椎骨折的影响[J].中国骨伤,2025,25(5):508~516 |
| 英文格式: | WANG Yue,LI Liang-sheng,CHEN Heng-mei,ZHENG Hai-lun,CHEN Shi-jie,CHEN Jian-quan,WANG Chun.Effect of the sequence of intermediate instrumentation and distraction-reduction of the injured vertebra on the treatment of thoracolumbar burst fractures with high rate of spinal canal encroachment[J].zhongguo gu shang / China J Orthop Trauma ,2025,25(5):508~516 |
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