桡骨远端关节内粉碎性骨折内外联合固定的手术疗效

1、桡骨远端关节内粉碎性骨折内外联合固定的手术疗效         10-05-03 11:31:00     编辑：studa20                  作者：李健，肖斌，赵洪普，高梁斌，范震波 【摘要】  目的评价经伤椎椎弓根钉固定结合经椎弓根植骨治疗胸腰椎爆裂骨折的临床疗效，

2、探讨其适应证。方法对30例胸腰椎爆裂骨折患者实施经伤椎椎弓根钉固定结合经椎弓根植骨术治疗，其中男22例，女8例，年龄1864岁。30例均为单一椎体损伤。术前伤椎前缘高度平均35，脊柱后凸角（Cobb角）26°，椎管正中矢状径55，神经功能按Frankel分级：A级4例，B级8例，C级5例，D级6例，E级7例。结果术后随访630个月，30例患者术后疼痛明显缓解（VAS评分改善），术后伤椎前缘平均高度恢复到97，脊柱后凸角（Cobbs角）为3.5°，椎管正中矢状径恢复到92，手术前后差异显著（P0.05）。术后神经功能恢复情况：A级2例，B级2例，C级5例，D级5例，E级16例

3、。术后骨折均获得复位，无1例发生内固定断裂、松动、矫正丢失等并发症。结论经伤椎椎弓根钉固定结合经椎弓根植骨术能让骨折获得满意复位，重建椎体高度，增强脊柱的抗压稳定性，减少内固定因应力过大造成的断钉、矫正丢失等并发症，是一种治疗胸腰椎爆裂骨折的有效方法。 【关键词】  胸腰椎损伤； 爆裂骨折； 椎弓根钉； 经椎弓根； 植骨术    Abstract：ObjectiveTo investigate curative effect for thoracolumbar burst fractures by the method of vertebral pedi

4、cle screw fixation applied in the with transpedicular bone graft,and consider its indications.MethodThirty cases of thoracolumbar burst fractures were treated by vertebral pedicle screw fixation combining transpedicular bone graft.Among them 22 were male and 8 were famale,age ranged 18-64.All of cas

5、es were single segment fractures.The average height of anterior border was 35% before the operation,the average of Cobb's angle was 26°,the percentage of midsagital diameter was 55%.According to Frankel's neurological function classification,preoperative neurological function was Grade

6、A in 4 cases,B in 8,C in 5,D in 6,E in 7.ResultAll cases were followed up for 6 to 30 months.All patients' pain relieved distinctly,the average height anterior border was increased to 97%,the average of Cobb's angle was 3.5°,the percentage of midsagital diameter was 92% postoperatively,

7、showing significant difference（P0.05）before and after operation.The postoperative neurological function was improved: Grade A in 2 cases,Grade B in 2,Grade C in 5,Grade D in 5,Grade E in 16.All the fracture were reduced and the internal fixation didn't loose and break,and there was no lost of co

8、rrection and other complications.ConclusionVertebral pedicle screw fixation with transpedicular bone graft can not only reduce verbebral fracture satisfactorily,increasing the stability of spine,but also decrease the possibility of breaking nail and correction loss.Therefore it is an effective metho

9、d of treating thoracolumbar burst fractures.    Key words：thoracolumbar injury;  burst fractures；  pedicle screw;  transpedicular；  bone graft    目前，经后路伤椎上、下相邻椎弓根螺钉内固定术仍为临床上治疗胸腰椎爆裂骨折的传统术式，但该术式存在椎体高度复位不佳，失败率较高1等不足。本院自2005年6月-2007年6月采用经伤椎椎弓根钉固定即3椎体5枚螺钉

10、结合经椎弓根植骨治疗胸腰椎爆裂骨折30例，该项新的术式在临床上获得满意疗效，现将病例报告如下。    1  资料与方法    1.1  一般资料    本组胸腰椎爆裂骨折患者30例，男22例，女8例；年龄1864岁，平均40岁；致伤原因：高处坠落伤14例，交通伤9例，重物砸伤7例。30例均为单一椎体骨折，骨折部位：T11 5例，T12 7例，L1 10例，L2 6例，L3 2例。按爆裂性骨折Denis分类2：A型4例，B型11例，C型5例，D型6例，E型4例。术前脊髓功能按Franke

11、l分级：A级4例，B级8例，C级5例，D级6例，E级7例。术前行X线检查，侧位片测得Cobbs角5°32°，平均26°，CT示椎体后壁不完整，部分骨折块凸入椎管，椎管变窄2050，术前伤椎前缘高度压缩至正常高度的3060。受伤至手术间隔时间210 d，平均6 d。    1.2  手术方法    手术在气管全麻或硬膜外麻醉下进行。病人俯卧于手术台上，以伤椎为中心，采取后正中切口，显露棘突、椎板和上、下小关节突，横突。在C型臂X线机透视下，按人字嵴顶点法进钉并在伤椎上、下椎常规植入4枚型号适当的椎

12、弓根螺钉撑开复位伤椎。根据伤情行椎板切除减压，清除椎管内碎骨块，再在X线透视下，经伤椎相对较完好的一侧椎弓根植入1枚椎弓根螺钉，植入后进行撬拔、敲击复位，如有后凸骨块占位者，用打入器将其打入。    将伤椎上的椎弓根螺钉拔出，并扩大该椎弓根孔道，用撬拔器将塌陷的终板复位，将切除的椎板和棘突剪碎，由椎弓根孔道植入，或将取下的髂骨修成骨粒植入，填满为止。将该枚椎弓根螺钉经伤椎椎弓根重新植入，安装上连接棒，可适当弯曲该连接棒，拧紧顶丝，术中透视下见复位满意。置连接杆固定，冲洗伤口，置负压引流管，逐层缝合伤口。    1.3  术后随访    所有患者术前、术后均行X线检查，部分患者行CT检查及MRI检查。从椎体前缘高度、脊柱Cobbs角、椎管狭窄程度、腰背痛、神经功能恢复情况、内固定并发症等方面进行评价手术效果。伤椎前缘高度按伤椎前缘高度与正常椎体前缘高度比值来评价，即伤椎前缘高度测量值