胸腰段脊柱爆裂骨折不同内固定方式的比较研究

目的：评价不同内固定器械的三维稳定性和对椎管的减压作用，为今后临床胸腰段脊柱爆裂骨折的治疗提供依据。方法：通过对１３例中、重度胸腰段脊信爆裂骨折标本进行不同内固定器械的固定，判断和观察脊柱节段的三维稳定性、椎管减压情况和椎间植骨的固定作用。结果：Ｓｔｅｆｆｅｅ，Ｋａｎｅｄａ器械可使重度爆裂骨折在屈曲、后伸及侧弯方向上较好地恢复脊柱的稳定性；Ｈａｒｒｎｇｔｏｎ在后伸时可保持稳定，在前屈、侧弯时虽优于

Comparative study of different internal fixations in treatment of thoracolumbar burst fracture

Objective: To evaluate the effects of internal fixation with different instruments. Methods: Thirteen injured segments with severe and moderate burst fracture were fixed by different instruments. The fixation effects of the instruments and intervertebral bone grafts on segment fixation were investigated by analysis of the 3 dimensional stability and their decompression of the spinal canal. Results: Treatment with Steffee or Kaneda instruments could well restore the stability of the spine in directions of flexion, posterior extension and lateral bend. Fixation with Harrington could keep the stability in the direction of posterior extension and was superior to Luque in maintaining the stability in directions of flexion and lateral bend, which were not significantly different as compared with the control group (P>0.05). In maintaining the stability of rotation, all of the instruments could only reduce the rotation of the injured segment by different degrees. However, it still exceeded the movement limitation of normal specimen, showing significant difference (P<0.05) in comparison with the normal group except for Kaneda. After intervertebral bone plantation, all of the instruments could markedly increase the segmental stability except for Luque. But only Kaneda could limit the segmental movement in axial rotation. Conclusion: Use of anterior pathway decompression, bone plantation and Kaneda instrument may be the best treatment for severe burst fracture. Steffee instrument can maintain the segmental stability and cause indirect decompression of the spinal canal. The fixation with Harrington is not effective, but shows the best benefit in decompression of the spinal canal. Luque is not beneficial for fixation and decompression. Bone plantation can prevent secondary posterior deformity and failure of instrumental fixation.