胸腰椎骨折后路手术后后凸趋势的研究

目的探讨胸腰椎骨折后路手术后,脊柱迟发后凸畸形以及患椎楔变趋势和原因。方法随访并回顾了1975年1月-2007年12月在宁夏医科大学附属医院骨科治疗的43例胸腰椎骨折患者,分成两组,第一组为椎弓根钉内固定组,第二组为保守治疗组,分别测量受伤时、术后即刻、术后1年、术后2年、随访时患椎的椎体楔变角、上下终板角。结果手术后椎弓根钉组各项指标均恢复,但在随访时各项指标又有不同程度的丢失,术前脊柱后凸（上下终板角）平均为19.5°、术后平均为8.6°、随访时平均为20°;术前患椎楔变角平均为20.7°、术后平均为9.1°、最后1次随访时平均为15.9°。保守治疗组在不同阶段随访时各项指标较受伤时均下降。结论胸腰椎骨折后路椎弓根钉固定术远期仍存在患椎高度丢失、椎体楔变,在2年后达到受伤时水平并保持稳定,脊柱后凸成角畸形是一个进行性的过程。

Research on late kyphosis deformity of thoracolumbar fracture

Objective To study the causes of late kyphosis deformity after posterior internal fixation of thoracolumbar fracture.Methods Between January 1975 and December 2007,43 patients with thoracolumbar fracture were treated.The patients were divided into 2 groups： pedicle screw fixation group and non-operation group.The wedged angle and superior-inferior endplate angle were respectively measured at four different stages： after injury,postoperation and following-up one year after operation and year after operation.Results After operation,the signs of the first group were restored,but at later follow up stage,the signs were decreasing gradually.The pedicle screw fixation group： Superior-inferior endplate angle： it was 19.5 degree before operation,it was 8.6 degree after operation;it was 20.0 degree at the time of following up.Wedged angle： it was 20.7 degree before operation,it was 9.1 degree after operation;it was 15.9degree at the time of following up.The second group： its signs decreasing gradually at the different stage of follow-up.Conclusion It is evidence that the height of the fractured vertebra may lose,the wedged vertebra may occur again since postoperation and keep steady after 2 yeas.But the spinal kyphosis deformity may go on.