经伤椎椎弓根椎体内植骨并置钉治疗胸腰椎骨折35例的疗效观察

目的探讨经伤椎椎弓根椎体内植骨并置钉治疗胸腰椎骨折的临床疗效。方法回顾分析采用经伤椎椎弓根椎体内植骨并置钉治疗胸腰椎骨折35例的临床资料。结果本组获随访9~24个月,平均15个月,35例术后伤椎前缘高度、cobb角及椎管正中矢状径恢复良好,手术前后差异有统计学意义(P<0.05),术后VSA评分改善,疼痛缓解良好。无一例发生椎间隙过度撑开、内固定松动断裂,后凸畸形改变,18例术后12~18个月行内固定物取出术,随访6个月未见明显椎体高度丢失及后凸畸形。结论经伤椎椎弓根椎体内植骨并置钉可使椎体骨折复位良好,重建椎体高度,恢复脊柱稳定性,有利于维持矫正效果,减少内固定松动断裂可能,是治疗胸腰椎骨折的一种有效方法。     

椎弓根钉治疗胸腰段骨折的一些问题

椎弓根钉短节段固定已普遍用于治疗胸腰椎损伤。国内外报道的疗效相差甚远［１～４］。我们在用此法治疗胸腰段损伤时发现多数疗效不理想，为此我们结合生物力学测试，将结果报告如下。临床资料１．一般资料：１９９０年１月～１９９３年７月，对１８例胸腰段骨折行Ｄｉｃ...     

经伤椎椎弓根置钉复位固定治疗胸腰椎骨折疗效分析

目的:探讨经伤椎椎弓根置钉治疗胸腰椎骨折的临床效果.方法:纳入2013年1月-2015年1月我科治疗的21例胸腰椎骨折患者,按照TLICS评分均大于4分,其中按AO分型,A型6例,B型15例,所有患者只累及一个椎体,均给予后路伤椎置钉内固定治疗.结果:本组研究所有患者均顺利完成手术,随访资料完整.术前Cobb角为(21.34±4.55)°,伤椎高度为(53.56±10.83)％,椎管面积为(45.35±16.24)％;末次随访Cobb角为(10.42±6.41)°,伤椎高度为(82.68±8.93)％,椎管面积为(90.33±10.56)％,术前及末次随访比较有统计学意义(P＜0.05).结论:后路伤椎置钉治疗胸腰椎骨折临床效果满意.     

经伤椎与跨伤椎短节段椎弓根钉内固定治疗脊柱骨折疗效对比

【摘要】 目的 对比分析经伤椎与跨伤椎短节段椎弓根钉内固定治疗脊柱骨折的临床疗效。 方法 选取2019年6月至2021年6月河南省第二人民医院收治的118例脊柱骨折患者作为研究对象, 按照不同手术方式将其分为观察组 (59 例) 和对照组 (59 例), 观察组患者采用经伤椎短节段椎弓根钉内固定治疗, 对照组患者采用跨伤椎短节段椎弓根钉内固定治疗, 对比观察两组患者围手术期相关情况、临床疗效以及椎体解剖结构恢复情况、椎体功能与生存质量。 结果 观察组患者术中出血量、手术时间及住院时间与对照组均无明显差异 ( t =0.731、0.722、0.585, P= 0.467、0.472、0.560);术后12个月, 观察组患者显效 45例、有效13 例、无效1例,明显优于对照组患者的显效 33例、有效 23 例、无效 3 例 (Z = -2.358, P = 0.018);术后 12 个月, 观察组患者Cobb角、椎体前缘高度压缩率、椎体后缘高度压缩率及椎管占位率均明显小于对照组 ( t = 10.670、9.967、11.720、7.632, P均<0.001);术后 12 个月, 观察组患者改良 Oswestry 功能障碍指数 (ODI) 评分明显低于对照组, WHO 生存质量测定量表简表 (WHOQOL-BREF) 评分明显高于对照组 ( t = 18.251、16.833, P 均<0.001)。结论 经伤椎短节段椎弓根钉内固定能更好地矫正脊柱骨折患者椎体解剖结构, 促进椎体功能恢复, 提高患者生活质量, 临床推广应用价值更高。     

椎弓根钉-棒内固定系统治疗胸腰段椎体骨折的临床效果分析

目的:探索观察椎弓根钉-棒内固定系统治疗胸腰段椎体骨折的临床效果情况.方法:选择2011年1月～2012年12月治疗的33例胸腰段椎体骨折患者作为研究对象,均采取椎弓根钉-棒内固定术治疗,观察术后的临床效果情况,进行综合分析.结果:33例胸腰段椎体骨折患者术后无并发症发生,椎体前缘高度从术前正常高度的62％ (51％ ～73％)恢复至正常高度的90％(84％ ～ 96％)改善明显;除3例全瘫患者的神经功能未得到改善,其余病例均恢复至正常.结论:椎弓根钉-棒内固定系统治疗胸腰段椎体骨折的临床效果良好,并发症少,是治疗胸腰段椎体骨折有效安全的手术方式.     

短节段椎弓根钉系统内固定用于胸腰段椎体骨折30例临床分析

目的 分析短节段椎弓根钉系统内固定用于治疗胸腰段椎体骨折的临床效果.方法 对30例确诊的胸腰段椎体骨折患者进行短节段椎弓根钉系统内固定治疗,对比术前、术后、随访X线平片和CT,并比较伤椎椎体前缘高度百分比(AVH％)、伤椎椎体后缘高度百分比(PvH％)、伤椎椎体角度和后凸畸形角度.结果 随访30例患者均达到临床骨性愈合,术后均没有出现内固定松动、断裂及切口感染等严重的并发症.结论 术后与术前AVH％比较,P＜0.01;术后与随访AVH％,P＞0.05,即术后伤椎椎体前缘高度立即恢复且没有丢失.伤椎椎体角度术前与术后,P＜0.01;术后与随访,P＜0.05.后凸畸形角度术前与术后,P＜0.01;术后与随访,P＜0.05.即术后伤椎椎体角度和后凸畸形角度恢复但在随访中存在丢失.神经功能恢复方面,术后1例B级升至C级,3例C级升至D级.随访中2例C级升至D级.短节段椎弓根钉系统内固定是治疗胸腰段椎体骨折的一种有效方法.     

经伤椎椎弓根椎体内植骨治疗胸腰椎骨折

目的探讨经椎弓根体内植骨治疗胸腰椎骨折的临床疗效。方法采用经椎弓根椎体内植骨,结合短节段椎弓根螺钉系统固定治疗胸腰椎骨折16例,以获得椎体前中柱的支撑。结果本组16例均获随访,术后椎体前后缘高度、脊柱生理曲度、神经功能恢复满意,无一例断钉现象。结论经椎弓根内固定结合伤椎椎体内植骨重建了椎体高度,增加了脊柱前中柱的稳定性,在减少迟发性腰背痛、Cobb角矫正度、内固定松动折断等并发症方面有明显效果。     

伤椎置钉单节段固定与短节段固定治疗胸腰段脊柱骨折分析

对32例胸腰段脊柱骨折分别采用经伤椎椎弓根置钉单节段固定（16例）和短节段固定（16例）治疗;两组在治疗后1周及末次随访时,伤椎后凸角、视觉模拟评分（VAS）无显著差异（P＞0．05）。单节段固定植骨融合治疗胸腰段骨折安全、有效、创伤相对更小,但局限适用于单侧终板损伤且椎弓根无骨折的胸腰椎骨折。     

屈曲应力损伤致胸腰段骨折经椎弓根内固定生物力学分析

目的本实验研究椎弓根系统对屈曲应力下两类型骨折固定生物力学特点。方法 实验分为二组，A、单纯椎体骨折组，B、推体骨折件三柱损伤组，分别用AF钉及RF钉固定。结果1、使用AF钉及RF钉固定，2000N负荷下，两组位移基本相似；2、2000N上，三柱损伤组位移稍增大，但统计学无显差异。结论经椎弓根固定系统对三柱损伤的推体压缩骨折固定的稳定性与单纯椎体压缩骨折相同。     

经皮经伤椎短节段椎弓根螺钉治疗单节段胸腰段椎体骨折

目的探讨采用微创经皮经伤椎短节段椎弓根螺钉固定治疗单节段胸腰段骨折的效果及优势。方法选择2010年1月~2013年8月收治的86例单节段胸腰段椎体骨折经伤椎短节段椎弓根螺钉固定手术患者进行回顾性分析,其中经皮置钉44例[A组,男性26例,女性18例;年龄19~50岁,平均(45.3±3.5)岁],开放置钉42例[B组,男性25例,女性17例;年龄18~53岁,平均(44.6±2.9)岁]。对两组围手术期相关指标、影像学表现、视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分进行分析。结果A组术中X线曝光次数较B组多,但手术时间、术中出血量、术后引流量均少于B组,并能获得更高的术后3d VAS评分,差异均有统计学意义(P0.001),而两组之间术前、术后即刻、术后随访过程中测量伤椎高度变化及Cobb角恢复情况大致相当,无统计学差异(P0.05),但术后与同组术前比较明显改善,有统计学差异(P0.05),A组术后早期及随访过程中ODI评分优于B组同一时间节点,差异有统计学意义(P0.05)。结论经伤椎置钉短节段固定治疗胸腰段骨折固定可靠,伤椎高度恢复良好且维持稳定,而经皮置钉在不影响疗效同时减少手术创伤,加快术后恢复,值得应用推广。     

伤椎置钉短节段内固定治疗单节段胸腰椎爆裂骨折

目的评估伤椎置钉后路短节段固定治疗单节段胸腰椎爆裂性骨折的临床疗效及影像学结果。方法回顾分析2008年5月~2014年5月采用伤椎置钉后路短节段固定治疗的胸腰椎爆裂性骨折且随访资料完整者68例,其中男性51例,女性17例;年龄18~62岁。评估患者术后并发症、Oswestry功能障碍指数(ODI)、术后伤椎高度矫正率、伤椎高度矫正丢失率、术后Cobb角矫正率、Cobb角矫正丢失率。结果所有患者均获得随访,时间12~94(平均47.3)个月。共3例(4.3%)患者出现术后并发症,其中切口浅表感染1例、螺钉穿透椎弓根内侧皮质2例,无一例内固定断裂。末次随访时,ODI为19.8%~29.2%[(24.4±7.6)%]、伤椎高度矫正率为91.3%~100%[(96.8±5.9)%],伤椎高度矫正丢失率为4.1%~8.2%[(7.6±2.4)%],Cobb角矫正率为83.6%~97.2%[(86.2±4.1)%]及Cobb角矫正丢失率为2.1%~6.7%[(5.8±3.4)%]。结论采用后路短节段椎弓根螺钉治疗胸腰椎爆裂性骨折时,伤椎置钉有利于恢复和维持伤椎高度、防止后凸畸形矫正及椎体高度丢失。     

经伤椎螺钉固定与跨伤椎螺钉固定治疗胸腰椎骨折疗效对比

目的：比较经伤椎万向螺钉固定与跨伤椎单向螺钉固定治疗胸腰椎骨折的疗效比较。方法选取2013年1月—2014年12月我院收治的胸腰椎骨折患者98例患者的临床资料,根据不同手术方式分为2组：经伤椎组（52例）和跨伤椎组（46例）。比较2组患者术前、术后3 d、末次随访矢状位后凸Cobb' s角度,伤椎椎体前缘高度百分比,术中出血量及手术时间。结果术前2组矢状位后凸Cobb' s角度、伤椎椎体前缘高度百分比相比较差异无统计学意义（P＞0.05）。2组椎体前缘高度百分比、矢状位后凸Cobb' s角度,术前与术后3 d比较差异均有统计学意义（P＜0.05）;末次随访,经伤椎组椎体前缘高度百分比和矢状位后凸Cobb' s角度,与术后3 d比较无统计学意义（P＞0.05）;末次随访跨伤椎组椎体前缘高度百分比和矢状位后凸Cobb' s角度与术后3 d比较差异有统计学意义（P＜0.05）。2组手术时间和术中出血量比较,差异无统计学意义（P＞0.05）。结论经伤椎与跨伤椎椎弓根螺钉固定治疗胸腰椎骨折均能够取得良好的效果,但在维持伤椎高度恢复,后凸畸形矫正方面,经伤椎固定优于跨伤椎固定。     

短节段经伤椎椎弓根螺钉治疗胸腰段骨折

目的 探讨短节段经伤椎椎弓根螺钉治疗胸腰段骨折的适应证、手术方法及临床疗效.方法 对我科从2005年1月至2008年12月收治的38例压缩性骨折和轻中度爆裂性骨折行短节段椎弓根螺钉内固定组(A组)和短节段经伤椎椎弓根螺钉内固定组(B组)各19例.采用伤椎椎体恢复度(R)值(伤椎前缘高度/临近椎体前缘高度的均值×100%)、伤椎后凸Cobb角、神经功能恢复情况(Frankel评分)、患者疼痛的视觉模拟疼痛评分(VSA)及内固定状况进行比较.结果 所有患者均得到6～37个月(平均20.5个月)随访.两种术式术后Frankel评分无明显差异,但B组VAS评分、R值、Cobb角恢复明显优于A组.A组出现螺帽松动、螺钉折弯各1例,无内固定物断裂、松动、脱出.结论 采用短节段经伤椎椎弓根螺钉是治疗压缩性和轻中度爆裂性胸腰段骨折的一种切实有效的方法.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.     

新型微创经皮椎弓根螺钉内固定治疗胸腰椎骨折

Objective To assess the minimally invasive surgical therapeutic result of percutane-ous pedicle screw fixation using Sextant-R system in treating thoracolumbar fractures. Methods A to-tal of 36 patients with thoracolumbar fractures were divided into two groups, ie, Sextant-R pereutaneous pedicle screw fixation group (Sextant-R group, 14 patients) and open pedicle screw fixation group (open surgery group, 22 patients). A comparative study was done on surgical incision, operation duration, sur-gical blood loss and deformity correction. Results In Sextant-R group and open surgery group respec-tively, the incision size was (7.1±0. 9) cm and (16.8 ± 1.6) cm (P <0. 05), operation duration (1.1±0.7) hoursand (2.4 ±0.8) hours (P<0.05), surgical blood loss (89.3 ±12.1) ml and (325.0±123.6) ml (P < 0.01), surgical draining loss (12.6 ± 3.2) ml and (147.3 ± 36.1) ml (P < 0. 01), postoperative improvement of Cobb' s angle (4.5 ± 2.4)° and (1.0± 2.3)° (P < 0. 05), sag-ittal index (10.2 ± 10.1)° and (5.5 ± 8.6)° (P < 0.05) and anterior height of fracture vertebral body (85.0 ±7.0)% and (95.5 ±2.2)% (P <0.05). Conclusion Pereutaneous pediele screw fixation using Sextant-R system is a good minimally invasive surgical choice for patients with thoracolumbar frac-ture under strict control of surgical indications.