前路内固定治疗胸腰椎严重爆裂骨折

目的评价Kaneda内固定装置与Z-plate内固定钢板系统治疗胸腰椎严重爆裂骨折的疗效.方法回顾分析62例前路减压、植骨加内固定术治疗的胸腰椎严重爆裂性骨折伤员,其中Kaneda内固定30例;Z-plate钢板内固定32例.结果两组伤员平均手术时间、平均手术出血量Z-plate组与Kaneda组比较,两组之间的差异有显著性(P＜0.05).62例患者均获得随访,平均随访6.6月(6～20个月).术后平均植骨融合时间、术后长期后凸矫正度丢失Z-plate组与Kaneda组比较,两组之间的差异无显著性(P＞0.05).两组伤员手术前后神经功能恢复情况(占小组例数),术后与术前比较差异有显著性(P＜0.05).术后Z-pIate组与Kaneda组比较差异无显著性(P＞0.05).结论两种前路手术内固定器均具有良好的减压、固定效果.Z-plate内固定钢板系统较之Kaneda固定装置手术操作简单,植入方便,可减少手术时间及手术出血量.

Treatment of severe burst fractures of thoraco-lumber spine with anterior internal fixation apparatus system

Objective To evaluate the outcomes of the treatment of severe burst fractures of thoraco- lumber spine with the use of anterior internal fixation apparatus system. Method Sixty two cases suffered from severe burst fractures of thoraco- lumber spine after trauma between 1999 and 2004 were divided into 2 groups according to the use of different anterior internal fixation apparatus system. Group Kaneda including 30 cases were managed by anterior decompression, autograft and Kaneda device internal fixation. Group Z- plate including 32 cases were managed by anterior decompression, autograft and Z- plate instrument internal fixation.ResultThe differences of average operative time and average amount of bleeding during operation between Group Z- plate and Group Kaneda had statistical significance (P <0.05). After an average duration of 6.6 months of follow- up ranging from 6 to 20 months, the differences of average interbody fusion time postoperative and the lose lyphosis postoperative between Group Z- plate and Group Kaneda had no statistical significance (P>0.05). The recover of neural function resulted from operation, the differences of neural function within the two groups themselves between postoperative and preoperative had statistical significance (P <0.05). That between the two groups postoperative had not statistical significance (P >0.05).ConclusionAnterior decompression, grafting and internal fixation can provide feasible effective decompression and strong fixation leading to excellent graft fusion. The Z- plate instrument system has more advantages than the Kaneda device system, such as easier and safer manipulation, with less amounts of bleeding, and shorter operative time.