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AF内固定治疗胸腰段脊柱骨折 总被引:3,自引:2,他引:1
目的 探讨AF内固定治疗胸腰段脊柱骨折的临床疗效。方法 对26例胸腰段脊柱骨折行AF内固定。结果 平均随访16个月,术后伤椎高度和Cobb角均有满意的恢复,神经功能按Frankel分级有1-3级改善。结论 AF内固定治疗胸腰段脊柱骨折操作简单、固定牢靠、疗效优良。 相似文献
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To determine the effect of adding pedicle screws at the level of a burst fracture (intermediate screws) on the stiffness of a short segment pedicle fixation, an in vitro biomechanical study was carried out. Six fresh-frozen pig lumbar spine specimens were used. The flexibility of the intact specimens was examined in flexion, extension, lateral bending, and torsion. An unstable burst fracture model was created by the dropped-mass technique. The unstable spine specimens were instrumented with pedicle screws. The flexibility was tested again with and without intermediate screws. The addition of intermediate screws provided a smaller range of motion in flexion-extension (P<0.001), torsion (P<0.001), and lateral bending (P=0.014). The slopes of the load displacement curves increased in flexion (P<0.001), extension (P=0.003), lateral bending (P=0.003), and torsion (P=0.006), signifying a decrease in flexibility. The addition of intermediate screws at the level of a burst fracture significantly increases the stiffness of a short segment pedicular fixation. 相似文献
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M. A. Erfani B. Pourabbas H. Nouraie I. Vadiee A. R. Vosoughi 《Musculoskeletal surgery》2014,98(2):107-114
Background
Researches on the results of surgical treatment of thoracolumbar spine fractures are infrequent. The aim of this study was to determine midterm outcomes of surgical treatment of these fractures in a prospective survey.Methods
A case series study on pediatric patients with the diagnosis of thoracic and/or lumbar vertebral fractures was conducted over a ten-year period. Surgically treated patients were evaluated in the follow-up period, based on back pain, independent function, neurological status, and radiographic indices.Results
There were 102 pediatric individuals, 61 boys and 41 girls, aged 3–17 years (mean 12 years of age) with thoracic and/or lumbar spinal fractures. Motor vehicle accident was the most common mechanism of injury (45.0 %). L1 was the most frequent level of fractured vertebra (24.4 %), and pelvic fracture was the most common associated orthopedic injury (21.5 %). Totally, 20 patients underwent surgery, but only fifteen (14 boys and one girl) participated in follow-up (mean 49 months; range 12–81 months). Posterior spinal fusion and instrumentation was accomplished in 12 cases. Three patients were operated by anterior approach and fusion followed by posterior fusion and instrumentation because of delay in diagnosis. There were no major perioperative complications. Two cauda equina syndromes and two incomplete spinal cord injuries improved back to normal. Five cases (33.3 %) reported occasional back pain, and all patients were functionally independent. Radiographic indices improved significantly.Conclusions
Spinal fusion and instrumentation in pediatric patients with unstable thoracolumbar vertebral fractures with or without spinal cord injuries have favorable radiographic and functional outcomes. 相似文献5.
Krüger A Rammler K Ziring E Zettl R Ruchholtz S Frangen TM 《Acta orthopaedica Belgica》2012,78(3):376-381
Open posterior instrumentation is still the standard procedure for unstable traumatic thoracic and lumbar fractures. There is a general tendency towards minimally invasive approaches in various surgical disciplines. The Sextant II Rod Insertion system is one of these. The authors prospectively studied this system in 51 patients with thoracic and lumbar fractures, between October 2007 and January 2011. Most fractures (31/51) were situated at the lumbar level. In 7 older patients the technique was combined with kyphoplasty and/or cement augmentation of the pedicle screws. The median operative time was 61 minutes (range: 26-130). The median fluoroscopy time was 132 seconds (range: 24-414). Most pedicle screws were correctly placed: 197 out of 204 screws. All fractures showed bony union after 6 weeks, but the multiaxial pedicle screws were not able to conserve the slight correction obtained peroperatively via positioning and longitudinal traction. Percutaneous minimally invasive stabilization of the spine needs further improvement. 相似文献
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The results of a morphometric study of selected human vertebrae undertaken to provide data for implant design are presented in this report. Twenty-seven dimensions were measured from thoracic (T2, T7, T12) and lumbar (L1-L5) vertebrae using prepared spinal columns from 30 skeletons belonging to the Hamann-Todd Osteological Collection. Maximum and minimum pedicle dimensions indicated that the pedicles are less symmetric cephalad than they are caudal. Vertebral body height increases caudally except posteriorly where, after an initial increase, it decreases in the lower lumbar region. Major and minor body diameters and the major spinal canal diameter slightly increase caudally, whereas minor spinal canal diameter exhibits little or no change. 相似文献
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M. Palmisani A. Gasbarrini G. Barbanti Brodano F. De Iure M. Cappuccio L. Boriani L. Amendola S. Boriani 《European spine journal》2009,18(Z1):71-74
We studied 51 patients with 64 fractures of the thoracolumbar and lumbar spine undergoing the surgical treatment by percutaneous
trans-pedicular fixation and stabilization with minimally invasive technique. Patient follow-up ranged from 6 to 28 months
(mean 14.2 months) and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous
trans-pedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to
be used in specific type of the thoracolumbar and lumbar spine fractures. 相似文献
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Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial
Purpose
The percutaneous insertion technique requires surgical skill and experience. However, there have been few clinical reports evaluating the accuracy of minimally invasive pedicle screw placement using the conventional fluoroscopy method. The purpose of this study was to evaluate the accuracy of percutaneous pedicle screw placement in the treatment of thoracic and lumbar spine fractures using two-plane conventional fluoroscopy.Methods
A prospective clinical trial was performed. A total of 502 percutaneous pedicle screws in 111 patients, all inserted with the assistance of conventional fluoroscopy, were evaluated. The safety and accuracy of pedicle screw placement were based on the evaluation of postoperative axial 3-mm slice computed tomography scans using the scoring system described by Zdichavsky et al. [Eur J Trauma 30:234–240, 2004; Eur J Trauma 30:241–247, 2004].Results
427/502 pedicle screws (85 %) were classified as good and excellent concerning the best possible screw length and 494/502 (98 %) were found to have good or excellent position. One screw had to be revised due to medial position with a neurological deficit.Conclusions
This study demonstrates the feasibility of placing percutaneous posterior thoracolumbar pedicle screws with the assistance of conventional fluoroscopy. Minimally invasive transpedicular instrumentation is an accurate, reliable and safe method to treat a variety of spinal disorders, including thoracic and lumbar spine fractures. 相似文献10.
Palmisani M. Gasbarrini A. Brodano G. Barbanti De Iure F. Cappuccio M. Boriani L. Amendola L. Boriani S. 《European spine journal》2009,18(1):71-74
We studied 51 patients with 64 fractures of the thoracolumbar and lumbar spine undergoing the surgical treatment by percutaneous trans-pedicular fixation and stabilization with minimally invasive technique. Patient follow-up ranged from 6 to 28 months (mean 14.2 months) and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous trans-pedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.
相似文献11.
To determine the adequacy of reduction and the soundness of the technique of primary internal fixation, the authors studied prospectively 96 femoral neck fractures over 6 1/2 years. Patients were followed up for an average of 11 months. The mean patient age was 70 years. Both clinical and radiologic data were collected at 3-month intervals for 6 months and then annually. Radiologic indices recorded included the Garden classification and index, shear angle, Western Infirmary Glasgow angle, lateral angle, nail placement, occurrence of bony union and presence of avascular necrosis. The fixation devices included sliding compression screw and side plate, multiple Knowles pins and a 130 degrees AO blade plate. A high rate of varus reduction, excessive ante- or retroversion and poor nail placement were all noted. Twenty-three patients required a total of 36 reoperations. There were six deaths in the first 6 months after operation. Eighty-five patients (mean age 79 years) with femoral neck fractures treated by hemiarthroplasty (71) or total hip replacement (14) during the same period were also reviewed. Follow-up averaged 8 months. Two patients required reoperation. The general morbidity was similar to that of the group treated by internal fixation, but there were eight deaths. Femoral neck fractures, if treated by internal fixation, demand accurate reduction and fixation for optimum results. Primary prosthetic replacement should be reserved for elderly patients with poor bone stock. 相似文献
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Posterior alloplastic fixation of a damaged spinal portion was accomplished in 68 patients. In 20 cases fracture was associated with spinal dislocation. In such cases when a compressive spinal fracture is accompanied with insignificant signs of spinal concussion one should follow an expectation policy, since an early operation may be inherent in some additional trauma and result in inhibition of regenerative processes. For spinal fixation Lavsan was employed in 23 patients, a tightening device-in 28, metallic CITO plates-in 17. In 6 objects fixation with the plates was associated with arthrodesis of intervertebral junctures. Late results were studied in 49 patients. In 40 cases the results were good, in 4-satisfactory, in 5-poor. The best results were noted in fixation of the damaged portion with the plates, these should be preferred to other fixators in fracture-dislocation of the spine. 相似文献
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目的 探讨单纯后正中入路经不同肌窗交叉窗口病灶清除、椎弓根钉-棒系统内固定治疗超长节段胸、腰椎结核的临床疗效。方法 自2005年1月至2011年1月采用后路正中切口、最长肌和多裂肌间隙行椎弓根钉-棒系统内固定,骶棘肌外缘设计双侧交叉窗口行侧前方病灶清除及植骨融合术治疗4节段以上的初治胸、腰椎结核患者17例,男10例,女7例;年龄19~68岁,平均39.8岁。病变累及4节段者6例、5节段者7例、6节段及以上者4例,包括2例跳跃病灶。Frankel分级:B级2例、C级3例、D级6例、E级6例。术前均给予营养支持,四联化疗3周以上;术后继续该方案3个月,然后采用三联化疗9~15个月。术后每个月复查尿酸、红细胞沉降率及肝功能。参考马远征脊柱结核病灶治愈标准对疗效进行评估。结果 所有病例均获得随访,平均随访时间27.9个月(18~48个月)。植骨融合时间平均6.3个月(4~11个月)。红细胞沉降率恢复正常时间平均为术后3.8个月(2~7.5个月)。Cobb角由术前的平均29.2°(11°~35°)矫正至术后2周时的平均9.6°(5.5°~14.8°)。合并神经损害的11例患者术后12个月随访时神经功能恢复正常9例,另2例恢复至Frankel D 级。末次随访CT检查示椎旁脓肿消失,无结核复发, 均骨性融合。结论 单纯后正中入路经不同肌窗交叉窗口病灶清除、内固定术能较好地一次性达到清除病灶、侧前方减压及植骨、病灶外矫形内固定、彻底引流,临床疗效满意。 相似文献
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目的 探讨应用后路钉棒内固定系统治疗胸腰椎骨折的临床效果。方法 自2009年1月至2010年12月,我科采用后路钉棒内固定系统联合或不联合椎管减压植骨融合治疗胸腰椎骨折33例,其中,男21例,女12例,年龄21~57岁,平均37.5岁。根据术前脊髓神经损伤Frankel评定分级:A级1例,B级2例,C级2例,D级10例,E级18例,术前Cobb角为23.40±1.64°,椎体平均高度前缘32.02±2.99% 和后缘78.27±1.65%。结果 本组平均手术时间为3.9h(3~5h),平均出血量为495mL(200~800mL),术后发生未伤口感染、血肿或其他严重并发症。经术后X线照片检查,未发现内固定材料断裂、松动以及胸腰椎骨折、移位。随访6~24个月,术后Cobb角为3.15±1.64°,椎体平均高度恢复到术后的前缘(90.15±1.72)%和后缘(98.09±1.14)%。神经功能恢复:A级1例,B级0例,C级1例,D级2例,E级29例。结论 后路钉棒系统手术相对简单、操作方便、固定可靠,是胸腰椎骨折的一种有效治疗方法。 相似文献
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PURPOSE: To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist. METHODS: From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study. Special care was taken during surgery to achieve articular congruity. The injury was caused by motor vehicle accidents in 13 cases and by a fall in 3. All cases were type-B3 fractures: 10 were of the B3.3 subtype, 4 of the B3.2 subtype, and 2 of the B3.1 subtype. Most (12) cases were operated on within one week of injury, 3 in one to 2 weeks, and one in 2 to 3 weeks. RESULTS: All patients were assessed clinically and radiographically after a mean follow-up duration of 32.4 months (range, 12.0-65.0 months). Fractures healed after 7.0 to 10.0 weeks (mean, 8.8 weeks). Results of evaluations according to functional criteria were excellent in 9 cases, good in 5, and fair in 2. Radiocarpal osteoarthrosis developed secondary to trauma in 2 cases. There was no involvement of the median nerve in any of the 16 cases. CONCLUSION: Open reduction and internal fixation of volar Barton's fracture can restore articular congruity and result in good to excellent function. 相似文献
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Michael Putzier Patrick Strube Julia F. Funk Christian Gross Hans-Joachim Mönig Carsten Perka Axel Pruss 《European spine journal》2009,18(5):687-695
The current gold standard in lumbar fusion consists of transpedicular fixation in combination with an interbody interponate
of autologous bone from iliac crest. Because of the limited availability of autologous bone as well as the still relevant
donor site morbidity after iliac crest grafting the need exists for alternative grafts with a comparable outcome. Forty patients
with degenerative spinal disease were treated with a monosegmental spondylodesis (ventrally, 1 PEEK-cage; dorsally, a screw
and rod system), and randomly placed in two groups. In group 1, autogenous iliac crest cancellous bone was used as a cage
filling. In group 2 the cages were filled with an allogenic cancellous bone graft. Following 3, 6, 9 and 12 months, the clinical
outcome was determined on the basis of: the Oswestry Low Back Pain Disability Questionnaire; patient satisfaction; patient
willingness to undergo the operation again; and a visual analog scale for pain. The radiological outcome was based on both
fusion rate (radiographs, computed tomography), and on the bone mineral density of the grafts. After 6 months, the X-rays
of the patients in group 2 had a significantly lower rate of fusion. Aside from this, there were no further significant differences.
After 12 months, radiological results showed a similar fusion rate in both groups. Donor site complications consisted of five
patients with hematoma, and three patients with persistent pain in group 1. No implant complications were observed. If a bone
bank is available for support and accepting the low risk of possible transmission of infectious diseases, freeze–dried allogenic
cancellous bone can be used for monosegmental spondylodeses. The results demonstrated an equivalent clinical outcome, as well
as similar fusion rates following a 12-month period. This is in despite of a delayed consolidation process. 相似文献
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Surgical stabilization of thoracic and lumbar spine fractures: a retrospective study in a military population 总被引:1,自引:0,他引:1
Twenty-two patients underwent surgical stabilization of thoracic and lumbar spine fractures. Twenty patients were operated on within 4 weeks of the injury and two patients more than 1 year following injury. Harrington rods were used in 21 and Dwyer instrumentation in one. The presenting neurological deficits were: four complete, five incomplete, and 13 intact. Clinical failure was noted in four patients, two of whom underwent posterior instrumentation more than 1 year following the initial injury. The most important contributing factor to failure was use of instrumentation in deviation from standard practice. The aim of operative treatment to maintain fracture reduction, decompress neural elements, promote fracture healing, and shorten hospitalization was achieved. 相似文献
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Syndesmotic fixation in supination-external rotation ankle fractures: a prospective randomized study
Pakarinen HJ Flinkkilä TE Ohtonen PP Hyvönen PH Lakovaara MT Leppilahti JI Ristiniemi JY 《Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society》2011,32(12):1103-1109
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目的探讨椎弓根钉棒系统治疗多节段胸腰椎脊柱骨折的手术方式与疗效。方法采用后路切开复位、椎弓根钉棒系统内固定、选择性椎管减压及后外侧植骨融合手术治疗44例多节段胸腰椎骨折患者,对患者术前与随访时的ASIA分级、伤椎椎体高度矫正率进行分析。结果全部患者平均随访12个月,未发现内固定物松动、断裂,椎体高度由术前平均49.3%恢复至术后平均92.5%。ASIA分级较术前平均提高1.2级。结论后路切开复位、椎弓根钉棒系统内固定基础上选择性椎管减压+植骨融合是治疗多节段胸腰椎脊柱骨折的理想选择。 相似文献
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Anterior fixation for burst fractures of the thoracic and lumbar spine with or without neurological involvement 总被引:7,自引:0,他引:7
J P Kostuik 《Spine》1988,13(3):286-293
This report details the use of the anterior approach for burst fractures of the thoracic and lumbar spine. The indication for dural decompression is acute neurological injury arising from significant canal intrusion. The use of anterior fixation devices, and in particular the anterior Kostuik-Harrington system, generally eliminates the necessity for a posterior approach. Anterior surgery has been performed in 80 cases for burst injuries of the thoracic and lumbar spine. Fifty-seven of these were paraparetic. While there were two cases of nonunion and 11 screw breakages, there were no early or late vascular or neurological complications. Average neurological recovery was 1.6 grades on the Frankel scale. All incomplete paraplegics recovered at least one grade. All complete paraplegics (four) failed to show any recovery. 相似文献