经骨折椎螺钉辅助复位方法的设计与应用

背景：骨折椎体置入螺钉固定能够分担内置物应力，增加固定强度，对后期骨折稳定性的维持更加有利。但能否通过骨折椎螺钉实施辅助复位，目前尚未见相关临床报道。目的：探讨自行设计的经骨折椎螺钉辅助复位方法的有效性。方法：2001年6月至2009年6月共收治161例胸腰椎骨折患者，男101例，女60例；年龄22-67岁，平均36岁。骨折按Denis分类：爆裂性骨折64例，屈曲压缩性骨折97例。骨折部位：T11 9例，T12 63例，L1 74例，L2 15例。采用自行设计的经骨折椎置钉方法辅助复位。依据患者手术时间、术中出血量、骨折愈合时间以及治疗前、治疗后骨折椎高度恢复程度、矢状面Cobb角、骨块复位情况评价该复位方法的有效性。 结果与结论：患者手术时间为60-150 min，平均80 min；术中出血量为67-750 mL，平均98 mL。161例患者术后获16-42个月随访。骨折愈合时间为10-18周，平均12.6周。骨折椎前缘高度比、矢状面Cobb角由治疗前的(54.39±9.60)%，(22.55±7.90)°提高至治疗后12个月的(82.80±6.63)%，(8.91±5.85)°，差异均有显著性意义(P < 0.05)。治疗后椎管面积较治疗前扩大(46.5±2.6)%。CT扫描显示骨块复位满意，无深部感染发生。提示自行设计的经骨折椎螺钉辅助复位方法可提高胸腰椎骨折的复位质量。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Design and application of screw-assisted reduction of fractured vertebrae

BACKGROUND:Screw fixation of the fractured vertebral body can share the stress of implant, increase fixing strength, and help to maintain the stability of late fracture. However, whether it can assist reduction using fracture vertebral screw, but no relevant clinical reports were found at present. OBJECTIVE:To explore the effectiveness of self-designed screw-assisted reduction of fractured vertebrae.  METHODS:161 cases of thoracolumbar fracture who had been hospitalized between June 2001 and June 2009 were enrolled in this study, including 101 males and 60 females, at the age of 22-67 years, averagely 36 years. By Denis classification, 64 cases affected burst fractures and 97 flexion-compression fractures. Fracture levels involved T11 (9 cases), T12 (63 cases), L1 (74 cases) and L2 (15 cases). The self-designed method of reduction assisted with screw insertion was used. The efficacy of this reduction method was evaluated by operation time, intraoperative bleeding, fracture union time, height ratio of anterior borders of injured and normal vertebrae,  sagittal Cobb’s angle, and reduction of fragments.  RESULTS AND CONCLUSION:The operation time ranged from 60 to 150 minutes, averaging 80 minutes. The intraoperative bleeding ranged from 67 to 750 mL, averaging 98 mL. The follow-up time ranged from 16 to 42 months in 161 patients. Fracture union time ranged from 10 to 18 weeks, averaging 12.6 weeks. The ratio of anterior heights and sagittal Cobb’s angle of fractured vertebrae were significantly improved from (54.39±9.60)% and (22.55±7.90)° respectively preoperatiion to (82.80±6.63)% and (8.91°±5.85)° 12 months postoperation (P < 0.05). The size of spinal canal was increased by (46.5±2.6)% postoperatively. CT scan revealed satisfactory fragment reduction and no deep infection appeared. These findings suggest that our self-designed screw-assisted reduction of the fractured vertebrae can improve the reduction quality in the treatment of thoracolumbar fractures.