复位五法结合内固定治疗胸腰段脊柱骨折脱位

目的:探讨手法复位技术在胸腰椎骨折脱位中的应用。方法:自2007年至2017年共诊治胸腰椎骨折脱位患者72例,分为治疗组与对照组。治疗组共37例,采用山东省名中医徐展望"牵压旋扳撑"复位五法,手术切开前先行手法复位,术中椎弓根钉棒系统撑开固定矫正残余移位及维持复位后位置。对照组35例只采用术中器械撑开复位固定。术后3 d所有患者均佩戴支具在床上坐起,下肢肌力在3级以上者下地活动。比较两组术后后凸Cobb角的改善以及侧方角度的改善情况,两组椎骨旋转角度改善情况及视觉模拟评分法(VAS)评分。结果:治疗组在侧方角度改善及椎骨旋转角度的改善方面明显优于对照组,治疗组侧方成角从平均17.46°±3.67°恢复到4.39°±1.23°;对照组从18.39°±4.12°恢复到8.12°±2.10°。两组比较差异有统计学意义(P0.01)。在椎骨旋转角度方面,治疗组恢复到6.02°±1.64°,对照组则恢复到14.91°±3.50°,两组比较差异有统计学意义(P0.01)。术后VAS均有明显改善,两组间对比差异无统计学意义。治疗组37例患者中治愈16例(43.24%),好转19例(51.35%),优良率94.59%。对照组35例中治愈11例(31.43%),好转19例(54.29%),优良率为85.71%。组间对比差异无统计学意义。选取典型病例,详细介绍了复位五法的应用情况。结论:手法复位可明显改善移位复杂严重的胸腰段骨折脱位,特别是脊柱的侧方成角以及椎骨的旋转移位。配合术中椎弓根钉棒系统撑开固定可达到满意的复位,且安全实用。

The Application of Manipulation Techniques Combined with Internal Fixation on Thoracolumbar Fracture and Dislocation

Objective:To explore the effect of manipulation techniques combined with internal fixation on thoracolumbar fracture and dislocation. Methods:72 patients treated from 2007 to 2017 for thoracolumbar fracture and dislocation were selected and divided into two groups. The treatment group(37 cases) were treated with manipulations before operation while the control group(35 cases) were treated with only with operations. Prof. XU Zhanwang put forward the theory of five manipulation techniques,which is traction,pressing,rotation,pulling and distraction. After the anesthesia is done,handful manipulation should be performed prior to surgical operation to largely improve the replacement of the dislocation. Pedicled screws and rod system then were planted with distraction to correct the residual displacement and to maintain the replaced position. Cobb angles of kyphosis had been compared between two groups along with lateral angles,rotation angles and VAS score. Results:The treatment group has a better result on lateral angle improvement and vertebral rotation angle improvement. The treatment group was significantly better than the control group in improving the lateral angle and the angle of rotation of the vertebrae. The lateral angle of the treatment group recovered from an average of 17.46°±3.67° to 4.39°±1.23°;the control group recovered from 18.39°±4.12° to 8.12°±2.10°. There was a statistically significant difference between the two groups(P<0.01). In terms of vertebral rotation angle,the treatment group recovered to 6.02°±1.64°,and the con trol group recovered to 14.91°±3.50°,which was statistically significant(P<0.01). There was a significant improvement in postoperative VAS,and there was no statistical difference between the two groups. 16 patients(43.24%) in the treatment group and 11 cases(31.43%) in the control group ended up with satisfied results. The application of this technique was illuminated below with a typical case. Conclusion:The handful manipulation before the surgical intervention successfully corrected most of the displacement of fracture and dislocation,especially with correction of lateral angle and rotation angle of spine. Followed with the internal fixation of screw and rod system,the displacement of thoracolumbar dislocation could be restored without the deterioration of nerve function.