• 1 綿陽市中心醫(yī)院脊柱外科（四川綿陽，621000）;2 綿陽市人民醫(yī)院骨科;

目的　 探討經(jīng)傷椎椎弓根螺釘內(nèi)固定治療胸腰椎骨折的臨床療效。 方法 　2008年5月－2010年12月，選擇38例胸腰椎骨折患者，采用椎弓根螺釘固定傷椎及相鄰上下椎體。其中男28例，女10例；年齡21～65歲，平均36.5歲。骨折部位：胸8 1例，胸9 2例，胸10 4例，胸11 8例，胸12 7例，腰1 10例，腰2 4例，腰3 2例。受傷至手術(shù)時(shí)間3～7 d，平均4.5 d。對(duì)患者手術(shù)前后椎體高度、矢狀面后凸Cobb角、神經(jīng)功能Frankel分級(jí)變化等指標(biāo)進(jìn)行測(cè)量并隨訪。 結(jié)果 　術(shù)后患者切口均Ⅰ期愈合。38例獲隨訪12～18個(gè)月，平均15個(gè)月。骨折均獲得骨性融合，無釘棒斷裂、無死亡或神經(jīng)損傷加重患者。術(shù)后神經(jīng)功能Frankel分級(jí)較術(shù)前有明顯改善（P＜0.05）。術(shù)后X線片復(fù)查示傷椎高度恢復(fù)達(dá)90%以上，外形正常；CT復(fù)查示椎管內(nèi)有效矢狀徑恢復(fù)滿意，椎管前方無明顯骨性壓迫，傷椎椎體骨愈合良好。術(shù)后1、12個(gè)月時(shí)傷椎前、后緣高度及后凸Cobb角均較術(shù)前顯著改善（P＜0.05）；術(shù)后12個(gè)月隨訪椎體高度無丟失。 結(jié)論 　經(jīng)傷椎椎弓根釘復(fù)位、減壓、內(nèi)固定治療胸腰椎骨折具有創(chuàng)傷小、固定節(jié)段少、脊柱穩(wěn)定性好、能有效矯正及預(yù)防脊柱后凸畸形等優(yōu)點(diǎn)。

引用本文： 宋晉剛,苗艷,崔易坤,尹振宇,黃海鋒,趙兵. 經(jīng)傷椎固定治療胸腰椎骨折的臨床研究. 華西醫(yī)學(xué), 2012, 27(8): 1146-1149. doi: 復(fù)制

1. 　Bailey CS, Dvorak MF, Thomas KC, et al. Companson of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial[J]. J Neurosurg Spine, 2009: 11(3): 295-303．.
2. 　Ragel BT, Allred CD, Brevard S, et al. Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices[J]. Spine (Phila Pa 1976), 2009, 34(22): 2400-2455．.
3. 　殷軍, 李愛民, 王寧, 等. 短節(jié)段加傷椎固定結(jié)合硫酸鈣填充治療胸腰椎爆裂骨折[J] . 中國(guó)脊柱脊髓雜志, 2011 , 21 (7) :561-565.
4. 　Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation[J]．J Spinal Disord Tech, 2010, 23(5): 293-301．.
5. 　Wei FX, Liu SY, Liang CX, et al. Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short- segment instrumentation[J]. Spine (Phila Pa 1976), 2010, 35(15): 714-720．.
6. 　Park WM, Park YS, Kim K, et al. Biomechanical companson of insIrumentation techniaues in treatment Of thoracolumbar burst fraclures: a finite elementanalysis[J]. J Orthop Sci, 2009, 14(4): 443-449．.
7. 　Liu S, Li H, Liang C, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(1): 38-44．.
8. 　Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J]. J Spinal Disord, 1994, 7(5):402-407.
9. 　宋無進(jìn), 蔡錦方．胸腰段骨折不同固定方式的有限元分析[J].中國(guó)組織工程研究與臨床康復(fù), 2009, 13(52): 10269-10273．.
10. 　Whang PG, Vaccaro AR, PoeIstra KA, et al. The influence of Fracture mechanism and morpholoqy on the reliability and validity of two novel thoracolumbar injury classification systems[J].Spine (Phila Pa 1976), 2007, 32(7): 791-795．.
11. 　呂夫新, 黃勇, 張強(qiáng), 等.胸腰椎骨折傷椎椎弓根內(nèi)固定生物力學(xué)研究與臨床應(yīng)用[J]. 脊柱外科雜志, 2008, 6(4): 229-234.
12. 　王洪偉, 李長(zhǎng)青, 周躍, 等. 脊柱骨折經(jīng)傷椎椎弓根置釘附加橫連短節(jié)段固定的穩(wěn)定性測(cè)試[J]. 中國(guó)脊柱脊髓雜志, 2010, 20(9): 745-749.
13. 　王洪偉, 李長(zhǎng)青, 周躍, 等. 傷椎置釘技術(shù)治療胸腰椎骨折的生物力學(xué)及臨床隨訪研究[J].中國(guó)脊柱脊髓雜志, 2011, 19(16): 1356-1360.
14. 　Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(6): 417-421.
15. 　黃海多, 楊有猛, 盧家靈.椎弓根螺釘內(nèi)固定間接減壓治療胸腰椎骨折療效觀察[J].臨床骨科雜志, 2008, 11(5): 446-449.
16. 　劉鵬, 李遠(yuǎn)安, 趙建華, 等.后路短節(jié)段固定融合術(shù)選擇性治療胸腰段爆裂性骨折[J]. 創(chuàng)傷外科雜志, 2008, 10(4): 333-336.
17. 　王文孝, 丁全峰, 張曉琴. 胸腰椎骨折椎弓根釘固定術(shù)后矯正度丟失的原因分析[J]. 中國(guó)脊柱脊髓雜志, 2002, 12(3): 186.
18. 　Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures[J]. Spine (Phila Pa 1976), 2005, 30(3): E73-79.
  1. 1. 　Bailey CS, Dvorak MF, Thomas KC, et al. Companson of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial[J]. J Neurosurg Spine, 2009: 11(3): 295-303．.
  2. 2. 　Ragel BT, Allred CD, Brevard S, et al. Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices[J]. Spine (Phila Pa 1976), 2009, 34(22): 2400-2455．.
  3. 3. 　殷軍, 李愛民, 王寧, 等. 短節(jié)段加傷椎固定結(jié)合硫酸鈣填充治療胸腰椎爆裂骨折[J] . 中國(guó)脊柱脊髓雜志, 2011 , 21 (7) :561-565.
  4. 4. 　Gelb D, Ludwig S, Karp JE, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation[J]．J Spinal Disord Tech, 2010, 23(5): 293-301．.
  5. 5. 　Wei FX, Liu SY, Liang CX, et al. Transpedicular fixation in management of thoracolumbar burst fractures: monosegmental fixation versus short- segment instrumentation[J]. Spine (Phila Pa 1976), 2010, 35(15): 714-720．.
  6. 6. 　Park WM, Park YS, Kim K, et al. Biomechanical companson of insIrumentation techniaues in treatment Of thoracolumbar burst fraclures: a finite elementanalysis[J]. J Orthop Sci, 2009, 14(4): 443-449．.
  7. 7. 　Liu S, Li H, Liang C, et al. Monosegmental transpedicular fixation for selected patients with thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(1): 38-44．.
  8. 8. 　Dick JC, Jones MP, Zdeblick TA, et al. A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation[J]. J Spinal Disord, 1994, 7(5):402-407.
  9. 9. 　宋無進(jìn), 蔡錦方．胸腰段骨折不同固定方式的有限元分析[J].中國(guó)組織工程研究與臨床康復(fù), 2009, 13(52): 10269-10273．.
  10. 10. 　Whang PG, Vaccaro AR, PoeIstra KA, et al. The influence of Fracture mechanism and morpholoqy on the reliability and validity of two novel thoracolumbar injury classification systems[J].Spine (Phila Pa 1976), 2007, 32(7): 791-795．.
  11. 11. 　呂夫新, 黃勇, 張強(qiáng), 等.胸腰椎骨折傷椎椎弓根內(nèi)固定生物力學(xué)研究與臨床應(yīng)用[J]. 脊柱外科雜志, 2008, 6(4): 229-234.
  12. 12. 　王洪偉, 李長(zhǎng)青, 周躍, 等. 脊柱骨折經(jīng)傷椎椎弓根置釘附加橫連短節(jié)段固定的穩(wěn)定性測(cè)試[J]. 中國(guó)脊柱脊髓雜志, 2010, 20(9): 745-749.
  13. 13. 　王洪偉, 李長(zhǎng)青, 周躍, 等. 傷椎置釘技術(shù)治療胸腰椎骨折的生物力學(xué)及臨床隨訪研究[J].中國(guó)脊柱脊髓雜志, 2011, 19(16): 1356-1360.
  14. 14. 　Guven O, Kocaoglu B, Bezer M, et al. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures[J]. J Spinal Disord Tech, 2009, 22(6): 417-421.
  15. 15. 　黃海多, 楊有猛, 盧家靈.椎弓根螺釘內(nèi)固定間接減壓治療胸腰椎骨折療效觀察[J].臨床骨科雜志, 2008, 11(5): 446-449.
  16. 16. 　劉鵬, 李遠(yuǎn)安, 趙建華, 等.后路短節(jié)段固定融合術(shù)選擇性治療胸腰段爆裂性骨折[J]. 創(chuàng)傷外科雜志, 2008, 10(4): 333-336.
  17. 17. 　王文孝, 丁全峰, 張曉琴. 胸腰椎骨折椎弓根釘固定術(shù)后矯正度丟失的原因分析[J]. 中國(guó)脊柱脊髓雜志, 2002, 12(3): 186.
  18. 18. 　Verlaan JJ, Dhert WJ, Verbout AJ, et al. Balloon vertebroplasty in combination with pedicle screw instrumentation a novel technique to treat thoracic and lumbar burst fractures[J]. Spine (Phila Pa 1976), 2005, 30(3): E73-79.