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| 矢状面弧度准确重建对治疗胸腰段脊柱骨折疗效的对比研究 |
| 朱小建1,曹建华1,夏小鹏2,朱蔚骏1,陈普建1,王文超1 |
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(1. 南通市第四人民医院骨科,南通 226005
2. 南通市中医院骨科,南通 226001
*通信作者) |
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| 摘要: |
| 目的 对比研究钛棒折弯角度的个性化设计在手术治疗胸腰段脊柱骨折中的中远期疗效。方法 将96例患者随机分为两组:治疗组50例,根据术前标准脊柱侧位片,利用均值法求出患椎运动节段的矢状面成角,所得值与患椎下运动节段矢状面成角、患椎上椎体矢状面成角的和作为所需固定节段的矢状面Cobb值,根据此角度值术中钛棒折弯并行后路复位固定；对照组46例,术中凭借经验弯棒,其他治疗均同。随访6个月以上,平均(18±5)个月,96例均术前、术后、末次随访时拍摄腰椎正侧位片,其中42例术前、末次随访均行CT检查,30例末次随访行磁共振检查。结果 影像学指标:治疗组末次随访的椎体前、后缘高度及Cobb角平均丢失分别为(1.06±0.46) mm、(0.42±0.26) mm、(1.57±0.51)°,对照组矫正的丢失分别为(2.73±0.86) mm (P<0.05)、(0.79±0.46) mm、(2.49±0.89)°（P<0.05）。治疗组鱼尾现象21例,对照组鱼尾现象25例。治疗组内固定失效率6%,对照组内固定失效率13%；治疗组末次随访22例,CT检查10例存在蛋壳现象,对照组20例CT检查9例存在蛋壳现象。有神经部分损伤的患者按Frankel分级均有1级以上的恢复。末次随访腰痛根据Oswestry功能障碍指数问卷评分:治疗组17例0分,15例2分,11例4分,2例6分,2例8分,1例56分,1例80分,1例88分；对照组10例0分,15例4分,11例6分,2例8分,2例10分,2例18分,2例50分,2例80分，两组差异有统计学意义(34% vs 21.74%, P<0.05)。 结论 经后路椎弓根内固定系统治疗胸腰段脊柱骨折时,术前个性化准确折弯钛棒能够较准确恢复矢状面生理弧度,减少椎体高度矫正的丢失,减少手术时间,降低内固定失败率,降低术后腰痛发生率,减少相邻节段退变。 |
| 关键词: 胸椎 腰椎 脊柱骨折 矢状面 |
| DOI： |
| 投稿时间：2013-05-13修订日期：2013-07-02 |
| 基金项目:南通市科技局指令性课题(S2010047). |
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| Accurate rebuilding of sagittal plane radian measure for treatment of thoracolumbar vertebrate fracture: a comparative study |
| ZHU Xiao-jian1,CAO Jian-hua1,XIA Xiao-peng2,ZHU Wei-jun1,CHEN Pu-jian1,WANG Wen-chao1 |
(1. Department of Orthopedics, the Fourth People’s Hospital of Nantong, Nantong 226005, Jiangsu, China
2. Department of Orthopedics, the Traditional Chinese Hospital of Nantong, Nantong 226001, Jiangsu, China
*Corresponding author.) |
| Abstract: |
| Objective To conduct a comparative study on the middle- and long-term efficacies of individualized titanium stick angular designs for treating thoracolumbar vertebrate fractures. Methods A total of 96 patients were divided into two groups,with 50 in the treatment group and 46 in the control group. The titanium stick in the treatment group was folded based on the numerical value which had been obtained by measuring and calculating the standard lateral projection of thoracolumbar vertebrate before the operation; the numerical value on sagittal plane was the sum of the average angle of its upper and subtus athletic segment, the angulation of subtus athletic segment and the angle of subtus vertebral body. The titanium stick in the control group was folded based on experience during the operation, with other treatments being the same. The patients were followed-up for at least 6 months, with an average of (18±5) months. All the patients received radiography examination pre- and post-operatively. And 42 patients received CT examination before and at the last follow-up; another 30 patients received MRI examination at last follow-up. Results At the final follow-up, the anterior, posterior vertebral heights were (1.06±0.46) mm and (0.42±0.26) mm for the treatment group and (2.37±0.86) mm (P<0.05) and (0.79±0.46) mm for the control group, respectively. The average loss of Cobb angle was (1.57±0.51)° in the treatment group and (2.49±0.89)° in the control group at final follow-up (P<0.05). The treatment group had 21 cases with fish tail and the control group had 25. The failure rate of internal fixation was 6% in the treatment group and 13% in the control group. The eggshell phenomenon on CT findings was found in 10 of the 22 patients in the treatment group and in 9 of the 20 cases in the control group at final follow-up. The neurological status was improved at least by 1 Frankel grade in the patients who had preoperative incomplete paraplegia. The scores of Oswestry Disability Questionnaire for the treatment group were: 0 in 17 cases, 2 in 15 cases, 4 in 11 cases, 6 in 2 cases, 8 in 2 cases, 56 in 1 case ,80 in 1 case, and 88 in 1 case; for the control group were 0 in 10 cases, 4 in 15 cases, 6 in 11 cases, 8 in 2 cases, 10 in 2 cases ,18 in 2 cases, 50 in 2 cases, and 80 in 2 cases. There were significant differente between the two groups （34% vs 21.74%, P<0.05）. Conclusion When transpedicle vertebral arch internal fixation system is used for treatment of thoracolumbar vertebrae fractures via posterior approach, individualized titanium stick angular design can accurately regain the physiologic curve of the fixed thoracolumbar segment,reducing operational time,loss of vertebral height correction, failure rate of internal fixation, incidence of backache, and degeneration of adjacent segment. |
| Key words: thoracic vertebrae lumbar vertebrae spinal fractures sagittal plane |
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