發(fā)布時(shí)間：2018-05-15 04:23

  本文選題：胸腰椎 + 骨折脫位��； 參考：《山東大學(xué)》2016年博士論文

【摘要】：第一部分經(jīng)傷椎單節(jié)段椎弓根螺釘固定治療胸腰椎骨折脫位的生物力學(xué)研究研究目的比較經(jīng)傷椎單節(jié)段4釘固定與傳統(tǒng)的跨傷椎4釘固定、含傷椎在內(nèi)的三椎體6釘固定治療胸腰椎骨折脫位的生物力學(xué)效果。研究經(jīng)傷椎單節(jié)段4釘固定治療胸腰椎骨折脫位的生物力學(xué)穩(wěn)定性。研究方法選取12具6-7月齡小豬胸腰段(T11-L2)脊柱標(biāo)本。經(jīng)X線透視排除脊柱腫瘤、畸形、感染以及骨質(zhì)疏松等病理狀態(tài)。剔除椎旁肌肉、脂肪等軟組織,保留椎骨、椎間盤、小關(guān)節(jié)囊以及周圍韌帶結(jié)構(gòu)。首先將12具脊柱標(biāo)本兩端(T11和L2椎骨)用義齒基托樹脂包埋,然后進(jìn)行脊柱完整狀態(tài)下的生物力學(xué)測(cè)試。測(cè)試完成后在每具標(biāo)本的T13椎體中上1/3處行楔形截骨,鋸斷T12/13椎間盤并切斷T12/13之間的棘上韌帶、棘間韌帶,鑿斷T12雙側(cè)下關(guān)節(jié)突,造成三柱損傷(保留雙側(cè)椎弓根完整)。咬除T12一側(cè)下關(guān)節(jié)突及椎板中、下2/3,咬除同側(cè)T13椎板上1/2,行椎板間開窗,顯露脊髓,制造開窗減壓模型,制成試驗(yàn)用的脊柱胸腰段骨折脫位模型。將12具胸腰段骨折脫位脊柱模型隨機(jī)分為3組,每組采用不同的固定方式進(jìn)行固定：A組采用經(jīng)傷椎置釘單節(jié)段固定(傷椎及上方脫位椎各置入兩枚椎弓根螺釘,行單節(jié)段4釘固定)；B組采用傳統(tǒng)的跨傷椎4釘固定(傷椎不置釘,傷椎相鄰的上、下椎體各置入兩枚椎弓根螺釘,雙節(jié)段4釘固定)；C組采用包括傷椎在內(nèi)的三椎體6釘固定(傷椎及傷椎的上、下相鄰的椎體各置入兩枚椎弓根螺釘,雙節(jié)段6釘固定)。應(yīng)用生物力學(xué)試驗(yàn)機(jī)(MTA)進(jìn)行力學(xué)測(cè)試,三維動(dòng)態(tài)檢測(cè)系統(tǒng)測(cè)定脊柱標(biāo)本T12/13完整狀態(tài)及三種固定組間載荷-位移及前屈、后伸、左側(cè)屈、右側(cè)屈、左旋、右旋6個(gè)方向的運(yùn)動(dòng)范圍(ROM)。采用SPSS 13.0統(tǒng)計(jì)軟件分析,所有數(shù)據(jù)采用x±s表示,所得完整狀態(tài)及三種固定組結(jié)果進(jìn)行對(duì)比,采用t檢驗(yàn)。為均衡數(shù)目的固定節(jié)段(A組T12-13；B組、C組T13-L1)對(duì)ROM的影響,采用用穩(wěn)定指數(shù)(stability potential index, SPI)反映兩種固定方法的即刻穩(wěn)定性,SPI=(完整狀態(tài)ROM-固定狀態(tài)ROM)/完整狀態(tài)ROM。統(tǒng)計(jì)檢驗(yàn)的顯著性均設(shè)定在a=0.05。結(jié)果：三組標(biāo)本固定后損傷節(jié)段軸向剛度比較：在最大載荷500N下,T12/13節(jié)段完整狀態(tài)下脊柱軸向壓縮平均位移為1.732±0.018mm；經(jīng)傷椎置釘單節(jié)段固定組(A組)平均位移為1.102±0.016mm；傳統(tǒng)的跨傷椎4釘固定組(B組)平均位移為1.372±0.032mm。含傷椎在內(nèi)的三椎體6釘固定組(C組)平均位移為1.098±0.010mm。軸向壓縮狀態(tài)下各固定組較完整狀態(tài)椎間位移均有明顯減少,有顯著差異性(P0.01)。提示三種固定方式固定后穩(wěn)定性較完整狀態(tài)明顯提高。固定后三組模型組間比較：經(jīng)傷椎置釘單節(jié)段固定組與含傷椎在內(nèi)的三椎體6釘固定組穩(wěn)定性無顯著性差異(P0.05),兩組穩(wěn)定性均高于傳統(tǒng)的跨傷椎4釘固定組(P0.05)。在屈、伸,左、右側(cè)屈及扭轉(zhuǎn)實(shí)驗(yàn)中：完整脊柱標(biāo)本的活動(dòng)范圍分別為1.72±0.92°,2.81±0.97°,1.71±0.75°,1.72±0.80°,3.55±0.77。,3.53±0.75°；單節(jié)段固定組(A組)的活動(dòng)范圍分別為：0.40±0.05°,0.48±0.08°,0.77±0.11°,0.76±0.09°,0.52±0.11°,0.53±0.09°；傳統(tǒng)的跨傷椎固定組(B組)的活動(dòng)范圍分別為：1.08±0.14°,0.97±0.11,1.05±0.19°,1.05±0.16°,0.69±0.14°,0.69±0.14°；含傷椎在內(nèi)的三椎體6釘固定組(C組)的活動(dòng)范圍分別為：0.30±0.07。,0.37±0.09°,0.75±0.12°,0.74±0.08°,0.49±0.16°,0.50±0.12°。三種不同方式固定后的脊柱模型穩(wěn)定性均高于完整狀態(tài)的脊柱(P0.01)。三種不同方式固定后的脊柱模型的穩(wěn)定性組間比較：在屈、伸實(shí)驗(yàn)中含傷椎在內(nèi)的三椎體6釘固定組的穩(wěn)定性強(qiáng)于經(jīng)傷椎置釘單節(jié)段固定組及傳統(tǒng)的跨傷椎4釘固定組(P0.05)；經(jīng)傷椎置釘單節(jié)段固定組穩(wěn)定性強(qiáng)于傳統(tǒng)的跨傷椎4釘固定組(P0.05)。在左、右側(cè)彎實(shí)驗(yàn)及扭轉(zhuǎn)實(shí)驗(yàn)中,經(jīng)傷椎置釘單節(jié)段固定組與含傷椎在內(nèi)的三椎體6釘固定組穩(wěn)定性無顯著性差異(P0.05),穩(wěn)定性均強(qiáng)于傳統(tǒng)的跨傷椎4釘固定組,具有顯著性差異(P0.05)。三組不同固定狀態(tài)下的脊柱模型在屈、伸,左、右側(cè)屈和扭轉(zhuǎn)實(shí)驗(yàn)中的穩(wěn)定指數(shù)(SPI, stable potential index)分別為：?jiǎn)喂?jié)段固定組(A組)：0.89±0.05,0.89±0.08,0.96±0.11,0.96±0.09,0.97±0.11,0.97±0.09；傳統(tǒng)的跨傷椎固定組(B組)：0.79±0.11,0.90±0.19,0.91±0.16,0.89±0.14,0.88±0.16；含傷椎在內(nèi)的三椎體6釘固定組(C組)：0.92±0.07,0.91±0.09,0.97±0.12,0.97±0.08,0.98±0.16,0.98±0.12。顯示含傷椎在內(nèi)的三椎體6釘固定組(C組)穩(wěn)定性與單節(jié)段固定組(A組)無顯著性差異(P0.05)；二者穩(wěn)定性均強(qiáng)于傳統(tǒng)的跨傷椎4釘固定組(B組),具有顯著性差異(P0.05)。結(jié)論：1.經(jīng)傷椎置釘?shù)膯喂?jié)段固定、傳統(tǒng)的跨傷椎雙節(jié)段固定及含傷椎在內(nèi)的三椎體6釘固定均能為骨折脫位的脊柱的建立即刻穩(wěn)定性。2.經(jīng)傷椎置釘?shù)膯喂?jié)段固定及含傷椎在內(nèi)的三椎體6釘固定的即刻穩(wěn)定性優(yōu)于傳統(tǒng)的跨傷椎固定組。3.經(jīng)傷椎置釘?shù)膯喂?jié)段固定治療胸腰椎脫位能提供足夠的即刻穩(wěn)定性。第二部分椎間后方加壓?jiǎn)喂?jié)段固定治療胸腰椎骨折脫位的臨床研究研究背景胸腰椎骨折脫位為典型的脊柱三柱損傷,極度不穩(wěn)定。除存在椎體、椎板、椎弓根、棘突等骨性結(jié)構(gòu)破壞外,多數(shù)合并前、后縱韌帶、棘上韌帶及椎間盤等軟組織斷裂,大多合并脊髓及神經(jīng)根損傷,手術(shù)指證明確。目前對(duì)其手術(shù)方式尚未形成共識(shí),前路手術(shù)可重建良好的前方支撐,但其復(fù)位困難,很難達(dá)到牢固的固定；同時(shí)后方結(jié)構(gòu)破壞無法修復(fù),遺留后方不穩(wěn)定；且椎管內(nèi)減壓困難,目前己較少采用。傳統(tǒng)的后路四釘跨傷椎復(fù)位固定技術(shù)由于力學(xué)懸掛效應(yīng),常常使骨折椎、脫位椎復(fù)位困難,且容易導(dǎo)致脫位的椎間隙過度撐開。近來多數(shù)學(xué)者采用包括傷椎在內(nèi)的三椎體六釘復(fù)位固定技術(shù),獲得滿意的效果。魏富鑫等采用小牛標(biāo)本模擬經(jīng)傷椎單節(jié)段固定和跨傷椎短節(jié)段固定治療胸腰椎骨折,證實(shí)兩種手術(shù)在重建脊柱穩(wěn)定性方面無顯著差異,為單節(jié)段固定提供了生物力學(xué)理論支持。既然傷椎可以置釘,有沒有必要同時(shí)固定其下方一個(gè)無辜的椎體?多固定融合一個(gè)正常的椎間隙?前期已有較多傷椎置釘?shù)纳锪W(xué)及解剖學(xué)研究,證實(shí)傷椎置釘?shù)目尚行�、可靠性。本研究第一部分已�?jīng)進(jìn)行動(dòng)物離體脊柱模型的生物力學(xué)研究,證實(shí)其穩(wěn)定性滿足固定要求,本節(jié)對(duì)其在臨床應(yīng)用中的療效進(jìn)行評(píng)價(jià)。研究目的比較后路切開復(fù)位椎間加壓?jiǎn)喂?jié)段內(nèi)固定,傳統(tǒng)的后路復(fù)位跨傷椎4釘內(nèi)固定,包括傷椎在內(nèi)的三椎體六釘復(fù)位內(nèi)固定三種手術(shù)方式在治療胸腰椎骨折脫位患者的臨床療效,為胸腰椎骨折脫位患者提供最佳治療策略。研究方法26例胸腰椎骨折患者隨機(jī)分為3組。A組：采用經(jīng)傷椎置釘?shù)淖甸g后方加壓?jiǎn)喂?jié)段內(nèi)固定技術(shù)；B組：采用傳統(tǒng)跨傷椎短節(jié)段內(nèi)固定技術(shù)；C組：采用包括傷椎在內(nèi)的三椎體六釘內(nèi)固定技術(shù)治療。26例胸腰椎骨折患者中A組10例；B組9例；C組7例。所有患者于傷后12天內(nèi)在全麻俯臥位下進(jìn)行手術(shù),根據(jù)分組采用不同的固定方式實(shí)施后路切開復(fù)位、椎管開窗減壓椎弓根釘內(nèi)固定術(shù)。術(shù)中盡量保留棘突及棘間韌帶、棘上韌帶結(jié)構(gòu),手術(shù)過程包括減壓、復(fù)位、置釘固定、后方融合,并縫合修復(fù)斷裂的棘突及棘上、棘間韌帶。本組病例均未行椎體間植骨融合�；颊咝g(shù)后均常規(guī)抗生素預(yù)防感染、消除神經(jīng)水腫及神經(jīng)營(yíng)養(yǎng)藥物治療及對(duì)癥處理。術(shù)后1周在支具保護(hù)下逐漸下地行走。26例患者均經(jīng)12個(gè)月以上隨訪,平均隨訪時(shí)間22.3個(gè)月比較三組間圍手術(shù)期指標(biāo)：手術(shù)時(shí)間、失血量、切口長(zhǎng)度、并發(fā)癥發(fā)生率；及術(shù)前／術(shù)后ASIA功能評(píng)分、骨折椎前緣高度比、脫位率、Cobb角椎管侵占率脊髓損傷率等指標(biāo)。采用SPSS 13.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,數(shù)據(jù)以x±s表示,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料(Frankel分級(jí))采用秩和檢驗(yàn)。結(jié)果末次隨訪時(shí)三組患者神經(jīng)功能(ASIA評(píng)分)較術(shù)前均有明顯提高(P0.05),三組患者組間比較神經(jīng)功能改善無顯著性差異(P0.05)。三組患者在手術(shù)時(shí)間、術(shù)中出血量、切口長(zhǎng)度及術(shù)后并發(fā)癥發(fā)生率方面：A組優(yōu)于B組及C組,有顯著性差異(P0.05)；B組手術(shù)時(shí)間短于C組,有顯著性差異(P0.05)；術(shù)中出血量、切口長(zhǎng)度及術(shù)后并發(fā)癥發(fā)生率方面B組及C組組間比較無顯著性差異(P0.05)。三組患者術(shù)前傷椎前緣高度比、Cobb角、脫位率及傷椎椎管侵占率的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。各影像學(xué)指標(biāo)：三組組內(nèi)比較術(shù)后比術(shù)前均有明顯改善,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪時(shí)三組傷椎前緣高度差異無統(tǒng)計(jì)學(xué)意義(P0.05)；而在Cobb角、脫位率及傷椎椎管侵占率的改善方面：A組、C組明顯優(yōu)于B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。A組、C組組間比較無顯著性差異(P0.05)。結(jié)論1.對(duì)于胸腰椎骨折脫位,椎間后方加壓?jiǎn)喂?jié)段內(nèi)固定、傳統(tǒng)的四釘跨傷椎復(fù)位內(nèi)固定及包括傷椎在內(nèi)的三椎體六釘復(fù)位內(nèi)固定術(shù)都能獲得較好的臨床功能恢復(fù)。2.椎間后方加壓?jiǎn)喂?jié)段內(nèi)固定的總體療效優(yōu)于傳統(tǒng)的跨傷椎四釘內(nèi)固定及包括傷椎在內(nèi)的三椎體六釘復(fù)位內(nèi)固定。
[Abstract]:Part 1 biomechanical study on the treatment of thoracolumbar fracture and dislocation through single segmental pedicle screw fixation for thoracolumbar fracture and dislocations. Objective to compare the biodynamic effects of the 4 nailed 4 nailed vertebrae and three vertebrae, including the injured vertebrae, and the three vertebral body with the injured vertebra for the treatment of thoracolumbar fracture dislocation. The biomechanical stability of the treatment of thoracolumbar fracture and dislocation. 12 6-7 months old piglet (T11-L2) spine specimens were selected to remove the pathological state of the spinal tumor, deformity, infection and osteoporosis by X-ray fluoroscopy. The paravertebral muscles, fat and other soft tissues were removed, and the vertebral, intervertebral disc, small joint capsule and the surrounding ligament structure were retained. First, a denture base resin was embedded at both ends of the 12 spine specimens (T11 and L2 vertebrae) with a denture base resin. Then the biomechanical test of the spinal integrity was performed. After completion of the test, the wedge osteotomy was performed at the upper 1/3 of the T13 vertebral body of each specimen. The T12/13 intervertebral disc was cut and the supraspinal ligaments, the interspinous ligaments, and the T12 bilateral lower joint processes were cut off from the T12/13. Three columns were damaged (preserving bilateral pedicle integrity). A model of thoracolumbar fracture and dislocation of the spine was made into 3 groups, each of the 12 thoracolumbar fractures and depressor models were divided into 3 groups randomly, by biting the lower 2/3 on the T12 side of the articular process and vertebral lamina, the lower 1/2 on the ipsilateral vertebral lamina, the interlaminar window, the spinal cord, and the decompression model of the open window, and the model of the thoracolumbar fracture dislocation. Group A was fixed in different fixed ways: group A was fixed with single segment of the injured vertebra (injured vertebra and upper dislocation vertebra each of two pedicle screws and single segment 4 nails); in group B, the traditional 4 nailed spanning vertebrae were fixed (injured vertebra without nail, adjacent to the injured vertebra, two pedicle screws in the lower vertebral body, and 4 segment fixed in the double segment). In group C, the three vertebrae, including 6 vertebrae including the injured vertebra, were fixed (the upper vertebrae and the injured vertebrae, the lower adjacent vertebral bodies were inserted into two pedicle screws and the double segment 6 nails). The biomechanical test machine (MTA) was applied to the mechanical test. The three-dimensional dynamic detection system was used to determine the complete state of the T12/13 in the spine specimens and the load displacement and the front of the three fixed groups. Flexion, extension, left flexion, right flexion, left rotation, dextral 6 direction movement range (ROM). Using SPSS 13 statistical software analysis, all data were expressed by X + s, the whole state and the three fixed groups were compared and t test was used. The effect of the equilibrium number of fixed segments (A group T12-13; B group, C group T13-L1) on ROM was used to use stability. The stability potential index (SPI) reflects the immediate stability of the two fixed methods. The significance of SPI= (complete state ROM- fixed state ROM) / complete state ROM. statistical test is set in the a=0.05. result: the axial stiffness comparison of the damaged segments after the three groups of specimens are fixed: under the maximum load 500N, the T12/13 section of the spinal column The average displacement of axial compression was 1.732 0.018mm, and the average displacement of the single segment fixation group (group A) was 1.102 + 0.016mm, the average displacement of the traditional 4 nail fixation group (group B) was 1.372 + 0.032mm. and the three vertebral 6 nail fixation group (C group) with the average displacement of 1.098 + 0.010mm. axial compression. The whole state of the intervertebral displacement was significantly reduced (P0.01). It was suggested that the stability of the three fixed methods was significantly improved after fixation. After fixation, there was no significant difference between the three groups of model groups: the stability of the three vertebrae, including the single segment fixation group and the three vertebrae, and the stability of the two groups. It was higher than the traditional 4 screw fixation group (P0.05). In the flexion, extension, left, right flexion and torsion test, the activity range of the complete spine specimen was 1.72 + 0.92, 2.81 + 0.97, 1.71 + 0.75, 1.72 + 0.80, 3.55 + and 3.53 + 0.75. The activity range of single segment fixation group (group A) was respectively 0.40 + and + 11 degrees, 0.76 + 0.09 degrees, 0.52 + 0.11 degrees, 0.53 + 0.09 degrees. The range of activities of the traditional intervertebral fixation group (group B) were 1.08 + 0.14, 0.97 + 0.11,1.05 +, 1.05 +, 0.16 [0.09]. The stability of the spinal model was higher than that of the intact spinal column (P0.01). The stability of the spinal model after the three different ways of fixation was compared with the stability of the spinal model after the three different ways of fixation. The stability of the three vertebral 6 nail fixation group in the flexion and extension experiment was stronger than that of the single segment fixation of the injured vertebral column in the flexion and extension experiment. The fixed group and the traditional 4 nail fixation group (P0.05), the stability of the single segment fixation group was stronger than the traditional 4 nail fixation group (P0.05). In the left, right bending experiment and torsion test, there was no significant difference in the stability between the single segment fixation group and the three vertebra 6 nail fixation group (P0.05). It is stronger than the traditional 4 nail fixation group of cross wound vertebra (P0.05). The stability index (SPI, stable potential index) in the three groups of different fixed states of the spinal model in the flexion, extension, left, right flexion and torsion (stable potential index) are:0.89 + 0.05,0.89 + 0.08,0.96 + 0.11,0.96 + 0.09,0.97 + 0.11,0.97 + 0 in the single segment group, respectively. .09; the traditional group (group B) was:0.79 + 0.11,0.90 + 0.19,0.91 + 0.16,0.89 + 0.16; the three vertebral 6 nail fixation group (group C) containing the injured vertebra (group C) showed the stability of the 6 nail fixation group in the three vertebral body and the single segment fixation group. There was no significant difference (P0.05). The stability of the two was stronger than that of the traditional 4 nail fixation group (group B) with a significant difference (P0.05). Conclusion: 1. the single segment fixation of the injured vertebral nail, the traditional trans vertebral double segmental fixation and the three vertebra 6 nail fixation, including the injured vertebra, can be the immediate stability of the fracture dislocation of the spine,.2. The immediate stability of the three vertebrae, including the single segment fixation of the injured vertebral nail and the three vertebra containing the injured vertebra, is superior to the traditional intervertebral fixation group. The treatment of thoracolumbar dislocation can provide sufficient immediate stability. Second partial posterior compression single segment fixation for the treatment of thoracolumbar fracture dislocation Research background, thoracolumbar fracture dislocation is a typical spinal three column injury, extremely unstable. Apart from the destruction of vertebral body, vertebral plate, pedicle, spinous process and other skeletal structures, most of the anterior longitudinal ligaments, supraspinal ligaments and intervertebral discs are broken, most of which are combined with spinal cord and nerve root injury, and the surgical indications are clear. At present, the operation method is clear. At present, the operation method is clear. At present, the operation method is clear. There is no consensus that anterior surgery can reconstruct a good front support, but its reduction is difficult and it is difficult to achieve a strong fixation. At the same time, the posterior structure failure can not be repaired, and the remnants of the posterior spinal canal are not stable, and the decompression of the spinal canal is difficult. The traditional posterior four nail cross wound fixation technique is often due to the mechanical suspension effect. It is difficult to reposition the fracture vertebra and dislocation vertebrae and easily lead to the excessive distraction of the dislocation of the vertebra. Most scholars recently adopted the technique of six nail reduction and fixation of three vertebrae including the vertebral body, and obtained satisfactory results. Wei Fuxin and other calf specimens were used to simulate the treatment of thoracolumbar fractures with single segmental fixation of the injured vertebra and short segmental fixation of the vertebra. There is no significant difference in the reconstruction of spinal stability between the two operations, which provides a biomechanical support for single segment fixation. Since the injured vertebra can be inserted, it is necessary to fix an innocent vertebral body at the same time at the same time? The first part of this study has carried out the biomechanical study of the animal model of the spinal column, which confirms that the stability meets the fixed requirements. The results of this section are evaluated in the clinical application. The purpose of this section is to compare the posterior reduction and reduction of the intervertebral compression single segment internal fixation and the traditional posterior reduction. The treatment of thoracolumbar fracture and dislocation in patients with thoracolumbar fracture and dislocation, including three vertebrae 4 nail internal fixation, including three vertebral body and six nail reduction and internal fixation, provides the best treatment strategy for patients with thoracolumbar fracture and dislocation. Methods 26 patients with thoracolumbar fracture were randomly divided into groups of 3.A groups: the posterior lumbar vertebra posterior to the posterior intervertebral body The technique of compression single segment internal fixation; group B: using the traditional intervertebral short segment internal fixation technique; group C: 10 cases of group A in.26 cases of thoracolumbar fractures, including 10 cases in.26 cases of thoracolumbar fractures, including six vertebrae including injured vertebrae, B group 9 cases and C group 7 cases. Posterior decompression, interspinous ligament and supraspinous ligament were retained in the operation. The procedure included decompression, reduction, fixation, posterior fusion, and suture repair of spinous process and spinous interspinous ligament. No intervertebral interbody bone was performed in this group. .26 patients were followed up for more than 12 months after 1 weeks of support. The average follow-up time was 22.3 months compared to the three groups: operation time, blood loss, incision length, and the average follow-up time of the three groups. The incidence of hair disease, ASIA function score before and after operation, the height ratio of anterior edge of fracture vertebra, dislocation rate, Cobb angle spinal canal embezzlement rate spinal cord injury rate and so on. The statistical analysis was carried out by SPSS 13 statistical software, the data were represented by X + s, the measurement data were tested by t test, and the count data (Frankel classification) were tested by rank sum test. The results were three at the last follow-up. The neurological function (ASIA score) of the group was significantly higher than that before the operation (P0.05). There was no significant difference in the improvement of nerve function between the three groups. In the three groups, the operation time, the amount of bleeding, the length of the incision and the incidence of postoperative complications: the group A was better than the B group and the C group (P0.05); the operation time of the B group was short. There was significant difference in group C (P0.05). There was no significant difference between group B and group C (P0.05) in the amount of intraoperative bleeding, incision length and postoperative complication rate (P0.05). There was no significant difference between the three groups in the anterior margin of the vertebral height, Cobb angle, dislocation and vertebral canal intraspinal embezzlement rate (P0.05). All imaging indexes: the internal ratio of the three groups The difference was statistically significant compared with that before operation (P0.05). There was no significant difference in the height difference between the three groups at the last follow-up (P0.05), but in the Cobb angle, the dislocation rate and the improvement of the vertebral canal embezzlement rate in the group A, the C group was obviously superior to the B group, and the difference was statistically significant (P0.05).A group, and there was no significant difference between the C group. Conclusion 1.. Conclusion 1. for thoracolumbar fracture dislocation, posterior intervertebral compression single segment internal fixation, traditional four nailed intervertebral reduction internal fixation and three vertebral six nail reduction internal fixation, including the injured vertebra, the overall effect of.2. posterior compression single segment internal fixation is better than that of the traditional one. Four pedicle screws and three pedicle screws were used to replace the three vertebrae.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687;R318.01

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