不同术式后路手术治疗胸腰椎骨折术后伤椎高度测量数据的临床意义
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摘要
目的探讨两种不同术式后路手术治疗胸腰椎骨折后伤椎椎体平均高度在术后1月、1年的变化和内固定失败率,比较两种不同手术方法的优劣。方法选取2006年1月~2012年1月,年龄在35~60岁之间胸腰椎骨折病例共计46例,根据两种不同方式后路手术将病人分为A组25例,B组21例。A组采用后侧入路经椎弓根短节段固定、椎板间植骨术。B组采取后侧入路经椎弓根短节段固定、经椎弓根植骨、伤椎重建、伤椎内固定术。分别测量其术后1月和术后1年的伤椎前后缘平均高度数据,并将数据进行比较。结果两组病例伤椎前后缘平均高度测量数据,术后1月A组为90.72%,B组为90.76%。术后1年A组为89.58%,B组为90.46%。两组数据经t检验,无明显差异,无统计学意义(P>0.05)。但A组有3例内固定失败。结论后路手术两种方式均可使用,但采用经椎弓根短节段固定,经椎弓根植骨、伤椎重建、伤椎内固定术从远期效果来看,尤其是青壮年患者更值得选用。
Objective To study on the effect of two different ways of posterior operation on treatment of thoracolumbar fracture.Methods 46 patients with thoracolumbar fracture were divided into group A and group B according to the two different ways in posterior operation.Group A took the posterior transarticular pedicle short segment fixation and vertebral lamina bone graft.Group B took the posterior transarticular pedicle,pedicle bone grafting,vertebral reconstruction,vertebral internal fixation.We measured the height of the injured vertebra 1month and 1year after operation.Results The measured results of the injured vertebra of Group A and Group B 1month after operation were 90.72%and90.76% and that 1year after operation were 89.58% and 90.46%(P>0.05).Conclusion The two way of posterior operation can get effect on treatment of thoracolumbar fracture.The posterior transarticular pedicle short segment fixation and vertebral lamina bone graft demonstrates advantages on long-term effects,especially on the young and middleaged patients.
Objective To study on the effect of two different ways of posterior operation on treatment of thoracolumbar fracture.Methods 46 patients with thoracolumbar fracture were divided into group A and group B according to the two different ways in posterior operation.Group A took the posterior transarticular pedicle short segment fixation and vertebral lamina bone graft.Group B took the posterior transarticular pedicle,pedicle bone grafting,vertebral reconstruction,vertebral internal fixation.We measured the height of the injured vertebra 1month and 1year after operation.Results The measured results of the injured vertebra of Group A and Group B 1month after operation were 90.72%and90.76% and that 1year after operation were 89.58% and 90.46%(P>0.05).Conclusion The two way of posterior operation can get effect on treatment of thoracolumbar fracture.The posterior transarticular pedicle short segment fixation and vertebral lamina bone graft demonstrates advantages on long-term effects,especially on the young and middleaged patients.
引文
[1]和卓亚.经椎弓根植骨后路短阶段固定治疗胸腰椎骨折16例[J].中国卫生产业,2014,11(3):148-149.
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[11]张贵林,荣国威,丁占云,等.脊椎胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析[J].中华骨科杂志,2000,20:470-472.
[12]周成洪,龙亨国,徐建广,等.后路经维弓根切除椎体三柱重建技术在胸腰椎爆裂型骨折的临床应用和疗效分析[J].中医正骨,2011,29(2):128-129.
[13]陈晓生,杨周生,庄泽红,等.经椎弓根治疗胸腰椎暴裂性骨折48例临床效果观察.[J].白球恩军医学院学报,2013,11(3):221-222.
[14]苏云山,任栋,王鹏程.脊柱Denis B型骨折行单节段与双节段融合后生物力学强度比较[J].中华骨科杂志,2013,33(7):748-754.
[15]谭家昌,徐鸿育.椎弓根螺钉治疗胸腰椎骨折后椎体矫正高度丢失的研究进展[J].实用骨科杂志,2010,16(3):190-193.
[2]戴力杨,蒋雷生,蒋盛旦.后路短节段固定治疗胸腰椎爆裂骨折[J].骨科动态,2009,5(4):193-200.
[3]殷渠东,郑祖根,董启榕.伴后柱分离损伤的胸腰椎爆裂型骨折[J].中华骨科杂志,2003,23(10):602-603.
[4]全必春,谭克赞,肖启平,等.椎弓根钉复位固定结合经椎弓根椎体内植骨术治疗胸腰椎骨折的疗效[J],现代中西医结合杂志,2014,23(4):403-404.
[5]冼敬锋,谭毅.胸腰椎骨折治疗进展研究[J].中国临床新医学,2012,6(5):571-371.
[6]徐宝山,唐天驷,胡永成.椎体成形术对胸腰椎爆裂骨折的治疗意义[J].中华骨科杂志,2002,22(12):738-742.
[7]赵轶波,赵斌,王永峰,等.经伤椎椎弓根椎体重建术的手术操作径线及重建范围[J].中华骨科杂志,2013,33(12):128-129.
[8]林伟平,周炳华,刘南.不同手术方式治疗胸腰椎爆裂骨折合并脊髓损伤的临床疗效观察[J].西部医学,2014,26(8):1032-1033.
[9]周飞,周文玉.经伤椎一侧椎弓根通道椎体内植骨并对侧椎弓根置钉固定治疗胸腰椎骨折[J].中国骨与关节损伤杂志,2008,4(2):271-273.
[10]苏松森.椎弓根钉复位固定结合经椎弓根椎体内植骨术治疗胸腰椎骨折[J].当代医学,2014,20(3):108-109.
[11]张贵林,荣国威,丁占云,等.脊椎胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析[J].中华骨科杂志,2000,20:470-472.
[12]周成洪,龙亨国,徐建广,等.后路经维弓根切除椎体三柱重建技术在胸腰椎爆裂型骨折的临床应用和疗效分析[J].中医正骨,2011,29(2):128-129.
[13]陈晓生,杨周生,庄泽红,等.经椎弓根治疗胸腰椎暴裂性骨折48例临床效果观察.[J].白球恩军医学院学报,2013,11(3):221-222.
[14]苏云山,任栋,王鹏程.脊柱Denis B型骨折行单节段与双节段融合后生物力学强度比较[J].中华骨科杂志,2013,33(7):748-754.
[15]谭家昌,徐鸿育.椎弓根螺钉治疗胸腰椎骨折后椎体矫正高度丢失的研究进展[J].实用骨科杂志,2010,16(3):190-193.