伤椎椎弓根置钉治疗下腰椎爆裂骨折临床分析

目的 比较分析后路器械椎弓螺钉固定下对伤椎置钉对下腰椎(L3～L5)爆裂骨折的临床疗效.方法 回顾性分析我科2001年1月至2008年12月收治的46例下腰椎爆裂骨折患者,按所采用的术式,18例行后路减压经椎弓根螺钉固定后外侧融合,伤椎置钉的患者为置钉组;28例行后路减压经椎弓根螺钉固定后外侧融合,伤椎未置钉的患者为未置钉组.通过比较术前、术后及随访时的病历资料,评价各组的脊柱矫形、伤椎复位及神经功能恢复情况.结果 2组患者术后随访4～30个月,平均18个月;椎体前高、后高、Cobb角随访时丢失率及丢失角度分别为:置钉组(2.3±0.5)%、(1.2±0.5)%、(0.5±0.1)°;未置钉组(7.7±0.5)%、(2.6±0.5)%、(3.1±0.1)°,2组差异有统计学意义(P＜0.05).2组术后Frankel分级平均改善1～3级,组间差异无统计学意义(P＞0.05).结论 下腰椎伤椎置钉组较未置钉组具有脊柱矫正率丢失低,脊柱稳定性好的优点,两组在神经功能恢复进步方面效果相近.

Abstract：

Objective To evaluate the clinical effect of whether or not fixing pedicel screw in injured vertebra. Methods We retrospectively studied 46 cases of lower lumbar burst fractures during January 2001 and December 2008. All cases were operated with back exposition,reduction and fixed with pedicle screw system. 18 cases were treated with progressing pedicel screw in injuryed vertebra,which was called the progressing pedicel screw group. 28 cases were not operated with progressing pedicel screw in injuryed vertebra,which was called the non-progressing pedicel screw group. Spina1 colume orthopaedic and Frankel grading were observed. Results Average follow-ups were 18 months. In the progressing pedicel screw group,the losing rate of the front height in vertebra body,the back height in vertebra body and cobb angle was (2.3 ±0.5)% ,(1.2 ±0.5)% ,(0.5 ±0.1)°. In the nonprogressing pedicel screw group,the losing rate of the front height in vertebra body,the back height in vertebra body and cobb angle was (7.7 ± 0.5)%,(2.6 ± 0.5)%,(3.1 ± 0.1) °. Frankel grading was increased with one or three grades after operation. Conclusions The progresing pedicel screw group has more merits than the non-progressing group,such as lower losing-rate of spinal colume orthopaedic,more quickly recovery,better stabilization of spina1 co1 umn. The two groups have same effects in terms of Frankel progress.

Treatment of lower lumbar burst fracture by fixing pedicel screw in injured vertebra

Objective To evaluate the clinical effect of whether or not fixing pedicel screw in injured vertebra. Methods We retrospectively studied 46 cases of lower lumbar burst fractures during January 2001 and December 2008. All cases were operated with back exposition,reduction and fixed with pedicle screw system. 18 cases were treated with progressing pedicel screw in injuryed vertebra,which was called the progressing pedicel screw group. 28 cases were not operated with progressing pedicel screw in injuryed vertebra,which was called the non-progressing pedicel screw group. Spina1 colume orthopaedic and Frankel grading were observed. Results Average follow-ups were 18 months. In the progressing pedicel screw group,the losing rate of the front height in vertebra body,the back height in vertebra body and cobb angle was (2.3 ±0.5)% ,(1.2 ±0.5)% ,(0.5 ±0.1)°. In the nonprogressing pedicel screw group,the losing rate of the front height in vertebra body,the back height in vertebra body and cobb angle was (7.7 ± 0.5)%,(2.6 ± 0.5)%,(3.1 ± 0.1) °. Frankel grading was increased with one or three grades after operation. Conclusions The progresing pedicel screw group has more merits than the non-progressing group,such as lower losing-rate of spinal colume orthopaedic,more quickly recovery,better stabilization of spina1 co1 umn. The two groups have same effects in terms of Frankel progress.