胸腰椎骨折的治疗进展
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摘要
目的:脊柱最常见的骨折部位常发生于胸腰椎连接处,大约占脊柱骨折的90%,胸腰椎骨折的治疗方案要根据骨折程度及类型进行制定。治疗胸腰椎骨折的目标是恢复脊柱的稳定性和阻止神经进一步损伤,从而使病人病情得到改善,保护脊柱、神经等组织,减轻病人骨折带来的痛苦,降低骨折并发症的发生率及最大限度的改善脊柱稳定性,从而使病人实现早期日常活动,尽早恢复日常生活。本文旨在通过对前人文章的学习、分析、归纳,对胸腰椎骨折的治疗作一综述。
The most common fracture sites in the spine often occur at the thoracolumbar connection,accounting for about 90% of the spine fracture.The treatment plan for the thoracolumbar fracture should be based on the degree and type of fracture.The treatment of thoracolumbar fractures is aimed at improving the stability of the spine and preventing further injury of the nerve,thus improving the patient's condition,protecting the spinal and nerve tissue,reducing the pain caused by the fracture of the patient,reducing the incidence of the fracture complications and improving the stability of the spine to the maximum.So that patients can achieve early daily activities,and restore their daily life as early as possible.The purpose of this article is to review the treatment of thoracolumbar fractures through learning,analyzing and summarizing previous articles.
The most common fracture sites in the spine often occur at the thoracolumbar connection,accounting for about 90% of the spine fracture.The treatment plan for the thoracolumbar fracture should be based on the degree and type of fracture.The treatment of thoracolumbar fractures is aimed at improving the stability of the spine and preventing further injury of the nerve,thus improving the patient's condition,protecting the spinal and nerve tissue,reducing the pain caused by the fracture of the patient,reducing the incidence of the fracture complications and improving the stability of the spine to the maximum.So that patients can achieve early daily activities,and restore their daily life as early as possible.The purpose of this article is to review the treatment of thoracolumbar fractures through learning,analyzing and summarizing previous articles.
引文
[1]Santiago FR,Muńoz PT,Sánchez EM,et al.Classifying thoracolumbar fractures:role of quantitative imaging[J].Quantitative Imaging in Medicine&Surgery,2016;6(6):772
[2]Sixta S,Moore FO,Ditillo MF,et al.Screening for thoracolumbar spinal injuries in blunt trauma:an eastern association for the surgery of trauma practice management guideline[J].J Trauma Acute Care Surg,2012;73(3):S326-32
[3]Goldstein CL,Chutkan NB,Choma TJ,et al.Management of the elderly with vertebral compression fractures[J].Neurosurgery,2015;77(4):S33
[4]Kortman K,Ortiz O,Miller T,et al.Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions[J].Journal of Neurointerventional Surgery,2013;5(5):461-6
[5]Mclain RF.Functional outcomes after surgery for spinal fractures:return to work and activity[J].Spine,2004;29(4):470
[6]Vaccaro AR,Lehman JR,Hurlbert RJ,et al.A new classification of thoracolumbar injuries:the importance of injury morphology,The integrity of the posterior ligamentous complex,And neurologic status[J].Spine,2005;30(20):2325
[7]Liu DG,Zhou H,Sun HH,et al.non-surgical treatment of thoracolumbar fractures[J].China Journal of Orthopaedics&Traumatology,2010;23(6):475-477
[8]Long HG,Huang W,Liu JX.Pneumatic reductor and reset drug pillow assisted with traction in the treatment of fresh thoracolumbar fractures[J].Journal of Traditional Chinese Orthopedics&Traumatology,2011
[9]Shimer AL,Su BW.Operative versus nonoperative treatment of thoracolumbar burst fractures[J].Seminars in Spine Surgery,2010;22(1):38-43
[10]Butler JS,Walsh A,O'byrne J.Functional outcome of burst fractures of the first lumbar vertebra managed surgically and conservatively[J].International Orthopaedics,2005;29(1):51-54
[11]Rea GL,Zerick WR.The treatment of thoracolumbar fractures:one point of view[J].Journal of Spinal Disorders,1995;8(5):368-82
[12]Khare S,Sharma V.Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures[J].Journal of Orthopaedics,2013;10(4):162-7
[13]周湘桂,李思云.骨质疏松性椎体压缩性骨折治疗研究进展[J].中国骨质疏松杂志,2012;18(11):1062-1065
[14]黄昊,何仕诚,方文,等.经皮椎体成形术治疗骨质疏松疼痛性椎体压缩性骨折的临床疗效分析[J].中华医学杂志,2014;94(27):2119-2122
[15]郑毓嵩,张勇,林金丁,等.椎体成形术骨水泥渗漏的相关危险因素分析[J].中华创伤杂志,2015;31(4):312-316
[16]Cook SD,Salkeld SL,Stanley T,et al.Biomeehaniealstudy of pedicle screw fixation in severely osteoporotic bone[J].Spine,2004;4(4):402-408
[17]刘达,康夏,郑伟,等.骨质疏松绵羊腰椎膨胀式椎弓根螺钉与骨水泥强化椎弓根螺钉固定稳定性的动态比较研究[J].中国脊柱脊髓杂志,2014;24(8):747-752
[18]刘达,吴子祥,雷伟,等.2种不同方法提高椎弓根螺钉稳定性的体外生物力学研究[J].中国骨与关节损伤杂志,2011;26(1):38-41
[19]高明暄,李旭升,甄平,等.膨胀螺钉及钉道强化在骨质疏松椎体中的力学可靠性研究[J].中华创伤骨科杂志,2014;16(6):521-526
[20]Poolman RW,Goslings JC,Lee JB,et al.Conservative treatment for closed fifth(small finger)metacarpal neck fractures[J].Cochrane Database Syst Rev,2005;5(3):CD003210
[21]Yi L,Jingping B,Gele J,et al.operative versus nonoperative treatment for thoracolumbar burst fractures without neurological deficit[M].The Cochrane Library.John Wiley&Sons,Ltd,2005;CD005079
[22]Altay M,Ozkurt B,Aktekin CN,et al.Treatment of unstable thoracolumbar junction burst fractures with short-or long-segment posterior fixation in magerl type a fractures[J].European Spine Journal,2007;16(8):1145-1155
[23]Jonathan-james TE,Chen JL,Mitsunaga MM.Short samesegment fixation of thoracolumbar burst fractures[J].Hawaii Journal of Medicine&Public Health A Journal of Asia Pacific Medicine&Public Health,2012;71(1):19-22
[24]Lazaro BC,Deniz FE,Brasiliense LB,et al.Biomechanics of thoracic short versus long fixation after3-column injury[J].Journal of Neurosurgery Spine,2011;14(2):226
[25]曾忠友,黄伟,张建乔,等.椎弓根螺钉系统同时经伤椎置钉固定治疗胸腰椎骨[J].中国脊柱脊髓杂志,2009;19(8):609-613
[26]Norton R P,Milne EL,Kaimrajh DN,et al.Biomechanical analysis of four-versus six-screw constructs for shortsegment pedicle screw and rod instrumentation of unstable thoracolumbar fractures[J].Spine,2014;14(8):1734-1739
[27]Lee JK,Jang JW,Kim TW,et al.Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:Is it effective:comparative study with open short-segment pedicle screw fixation with posterolateral fusion[J].Acta Neurochir,2013;155(12):2305-2312
[28]孙天全,厉运收.经椎弓根后路短节段非融合固定治疗胸腰椎骨折[J].中国矫形外科杂志,2012;20(18):1670-1672
[29]徐院生,赵红军,苏明海,等.后路长节段非融合椎弓根螺钉固定技术治疗胸腰椎骨折[J].颈腰痛杂志,2013;34(1):43-45
[30]Hitchon PW,Torner J,Eichholz KM,et al.Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures[J],2006;5(2):117-125
[31]Sasso RC,Renkens K,Hanson D,et al.Unstable thoracolumbar burst fractures:anterior-only versus shortsegment posterior fixation[J].Journal of Spinal Disorders&Techniques,2006;19(4):242-248
[2]Sixta S,Moore FO,Ditillo MF,et al.Screening for thoracolumbar spinal injuries in blunt trauma:an eastern association for the surgery of trauma practice management guideline[J].J Trauma Acute Care Surg,2012;73(3):S326-32
[3]Goldstein CL,Chutkan NB,Choma TJ,et al.Management of the elderly with vertebral compression fractures[J].Neurosurgery,2015;77(4):S33
[4]Kortman K,Ortiz O,Miller T,et al.Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions[J].Journal of Neurointerventional Surgery,2013;5(5):461-6
[5]Mclain RF.Functional outcomes after surgery for spinal fractures:return to work and activity[J].Spine,2004;29(4):470
[6]Vaccaro AR,Lehman JR,Hurlbert RJ,et al.A new classification of thoracolumbar injuries:the importance of injury morphology,The integrity of the posterior ligamentous complex,And neurologic status[J].Spine,2005;30(20):2325
[7]Liu DG,Zhou H,Sun HH,et al.non-surgical treatment of thoracolumbar fractures[J].China Journal of Orthopaedics&Traumatology,2010;23(6):475-477
[8]Long HG,Huang W,Liu JX.Pneumatic reductor and reset drug pillow assisted with traction in the treatment of fresh thoracolumbar fractures[J].Journal of Traditional Chinese Orthopedics&Traumatology,2011
[9]Shimer AL,Su BW.Operative versus nonoperative treatment of thoracolumbar burst fractures[J].Seminars in Spine Surgery,2010;22(1):38-43
[10]Butler JS,Walsh A,O'byrne J.Functional outcome of burst fractures of the first lumbar vertebra managed surgically and conservatively[J].International Orthopaedics,2005;29(1):51-54
[11]Rea GL,Zerick WR.The treatment of thoracolumbar fractures:one point of view[J].Journal of Spinal Disorders,1995;8(5):368-82
[12]Khare S,Sharma V.Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar fractures[J].Journal of Orthopaedics,2013;10(4):162-7
[13]周湘桂,李思云.骨质疏松性椎体压缩性骨折治疗研究进展[J].中国骨质疏松杂志,2012;18(11):1062-1065
[14]黄昊,何仕诚,方文,等.经皮椎体成形术治疗骨质疏松疼痛性椎体压缩性骨折的临床疗效分析[J].中华医学杂志,2014;94(27):2119-2122
[15]郑毓嵩,张勇,林金丁,等.椎体成形术骨水泥渗漏的相关危险因素分析[J].中华创伤杂志,2015;31(4):312-316
[16]Cook SD,Salkeld SL,Stanley T,et al.Biomeehaniealstudy of pedicle screw fixation in severely osteoporotic bone[J].Spine,2004;4(4):402-408
[17]刘达,康夏,郑伟,等.骨质疏松绵羊腰椎膨胀式椎弓根螺钉与骨水泥强化椎弓根螺钉固定稳定性的动态比较研究[J].中国脊柱脊髓杂志,2014;24(8):747-752
[18]刘达,吴子祥,雷伟,等.2种不同方法提高椎弓根螺钉稳定性的体外生物力学研究[J].中国骨与关节损伤杂志,2011;26(1):38-41
[19]高明暄,李旭升,甄平,等.膨胀螺钉及钉道强化在骨质疏松椎体中的力学可靠性研究[J].中华创伤骨科杂志,2014;16(6):521-526
[20]Poolman RW,Goslings JC,Lee JB,et al.Conservative treatment for closed fifth(small finger)metacarpal neck fractures[J].Cochrane Database Syst Rev,2005;5(3):CD003210
[21]Yi L,Jingping B,Gele J,et al.operative versus nonoperative treatment for thoracolumbar burst fractures without neurological deficit[M].The Cochrane Library.John Wiley&Sons,Ltd,2005;CD005079
[22]Altay M,Ozkurt B,Aktekin CN,et al.Treatment of unstable thoracolumbar junction burst fractures with short-or long-segment posterior fixation in magerl type a fractures[J].European Spine Journal,2007;16(8):1145-1155
[23]Jonathan-james TE,Chen JL,Mitsunaga MM.Short samesegment fixation of thoracolumbar burst fractures[J].Hawaii Journal of Medicine&Public Health A Journal of Asia Pacific Medicine&Public Health,2012;71(1):19-22
[24]Lazaro BC,Deniz FE,Brasiliense LB,et al.Biomechanics of thoracic short versus long fixation after3-column injury[J].Journal of Neurosurgery Spine,2011;14(2):226
[25]曾忠友,黄伟,张建乔,等.椎弓根螺钉系统同时经伤椎置钉固定治疗胸腰椎骨[J].中国脊柱脊髓杂志,2009;19(8):609-613
[26]Norton R P,Milne EL,Kaimrajh DN,et al.Biomechanical analysis of four-versus six-screw constructs for shortsegment pedicle screw and rod instrumentation of unstable thoracolumbar fractures[J].Spine,2014;14(8):1734-1739
[27]Lee JK,Jang JW,Kim TW,et al.Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures:Is it effective:comparative study with open short-segment pedicle screw fixation with posterolateral fusion[J].Acta Neurochir,2013;155(12):2305-2312
[28]孙天全,厉运收.经椎弓根后路短节段非融合固定治疗胸腰椎骨折[J].中国矫形外科杂志,2012;20(18):1670-1672
[29]徐院生,赵红军,苏明海,等.后路长节段非融合椎弓根螺钉固定技术治疗胸腰椎骨折[J].颈腰痛杂志,2013;34(1):43-45
[30]Hitchon PW,Torner J,Eichholz KM,et al.Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures[J],2006;5(2):117-125
[31]Sasso RC,Renkens K,Hanson D,et al.Unstable thoracolumbar burst fractures:anterior-only versus shortsegment posterior fixation[J].Journal of Spinal Disorders&Techniques,2006;19(4):242-248