本文選題：腰椎骨折 + 短節(jié)段��； 參考：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)對(duì)使用后路短節(jié)段內(nèi)固定術(shù)治療的腰椎A(chǔ)型骨折患者進(jìn)行研究,研究不同內(nèi)固定取出時(shí)間對(duì)固定未融合節(jié)段的影響。方法:回顧性研究寧夏醫(yī)科大學(xué)總醫(yī)院脊柱骨科2013年9月～2016年9月期間應(yīng)用后路短節(jié)段椎弓根螺釘內(nèi)固定融合術(shù)治療的腰椎骨折病例80例,其中男性45例,女性35例,年齡32～55歲,平均38歲;隨訪時(shí)間12～24月,平均18月;致傷原因:墜落傷30例(37.5%),交通事故傷35例(43.8%),摔傷5例(6.2%),重物砸傷10例(12.5%);骨折節(jié)段:均為單節(jié)段骨折,其中:L1骨折32例(40%),L2骨折25例(31.3%),L3骨折18例(22.5%),L4骨折5例(6.2%),L5骨折0例(0%);骨折類型:按照AO分型,全部為A型骨折,其中A1型49例(61.2%),A2型26例(32.5%),A3型5例(6.3%);所有患者均無(wú)脊髓、神經(jīng)損傷。根據(jù)術(shù)后內(nèi)固定取出時(shí)間分為兩組:A組:術(shù)后一年取內(nèi)固定者,共40例;B組:術(shù)后二年取內(nèi)固定者,共40例。80例患者均在骨折術(shù)前及內(nèi)固定取出后行腰椎正側(cè)位X線片、CT、MRI檢查。X線片上測(cè)量骨折術(shù)前、內(nèi)固定取出后傷椎前、中、后緣高度、椎體楔變角,末次測(cè)量值與骨折術(shù)前測(cè)量值之差為糾正丟失值;觀察腰椎骨折術(shù)前、內(nèi)固定取出后腰椎CT與MRI圖像,應(yīng)用Weishaup影像分級(jí)標(biāo)準(zhǔn)評(píng)價(jià)固定未融合節(jié)段小關(guān)節(jié)退變,用Modic退變標(biāo)準(zhǔn)、Pfirrmann分級(jí)系統(tǒng)評(píng)價(jià)固定未融合節(jié)段終板退變及椎間盤(pán)退變情況。應(yīng)用SPSS17.0軟件進(jìn)行分析,比較2組固定未融合節(jié)段的退變差異。結(jié)果:1.A組及B組患者椎體楔變角矯正丟失值分別為1.42±1.26和2.83±2.09;A組及B組患者內(nèi)固定取出后與骨折術(shù)前AVH、MVH、PVH和椎體楔變角相比,除術(shù)前MVH(P=0.095)、MVH矯正丟失(P=0.057),2組數(shù)據(jù)無(wú)統(tǒng)計(jì)學(xué)差異,余各組數(shù)據(jù)比較,差異均具有統(tǒng)計(jì)學(xué)差異(P0.05)。2.A、B兩組患者骨折術(shù)前和內(nèi)固定取出后固定未融合節(jié)段小關(guān)節(jié)退變比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);A、B兩組患者骨折術(shù)前和內(nèi)固定取出后固定未融合節(jié)段椎間盤(pán)退變比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);A、B兩組患者骨折術(shù)前和內(nèi)固定取出后固定未融合節(jié)段終板退變比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.腰椎A(chǔ)型骨折短節(jié)段內(nèi)固定術(shù)后1年取內(nèi)固定與術(shù)后2年取內(nèi)固定患者相比,固定未融合節(jié)段均有不同程度退變,但術(shù)后1年較術(shù)后2年取出內(nèi)固定能有效減緩固定未融合節(jié)段退變。結(jié)論:后路短節(jié)段內(nèi)固定術(shù)治療腰椎A(chǔ)型骨折臨床療效滿意;術(shù)后1年取出內(nèi)固定能有效減緩固定未融合節(jié)段退變。
[Abstract]:Objective: to study the effect of different removal time of internal fixation on the unfused segment of lumbar vertebrae A fracture treated by posterior short segment internal fixation. Methods: a retrospective study was made on 80 cases of lumbar fractures treated by posterior short pedicle screw fixation and fusion from September 2013 to September 2016 in the Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, including 45 males and 35 females. The age was 32 to 55 years (mean 38 years); the follow-up period was 12 to 24 months, with an average of 18 months. The causes of injury were: falling injury in 30 cases, traffic accident injury in 35 cases, falling injury in 5 cases, smashing in 5 cases, and heavy object injury in 10 cases, the fracture segment was all single segment fracture, There were 32 cases of L _ 1 fracture and 25 cases of L _ 2 fracture. 18 cases of L _ 3 fracture were compared with that of L _ 3 fracture. 5 cases of L _ 4 fracture were divided into 6. 2 and L _ 5 fractures. According to AO classification, all of them were type A fractures, of which 49 cases were type A1 type 61.2A _ 2 type A _ 2 type and 26 cases were 32.5 and A3 type. All the patients had no spinal cord or nerve injury. According to the time of removal of internal fixation, they were divided into two groups: one year after operation, 40 cases were treated with internal fixation, and 40 cases were treated with internal fixation two years after operation. A total of 40 cases (80 cases) were examined with CT MRI before and after the removal of internal fixation. The anterior, middle and posterior edge height and wedge angle of the vertebral body were measured before and after the removal of internal fixation. The difference between the last measurement value and the preoperative measurement value of fracture was the corrected loss value, the CT and MRI images of lumbar vertebrae were observed before and after the removal of internal fixation, and the Weishaup imaging grading standard was used to evaluate the degeneracy of unfused segmental facet joints. Modic standard Pfirrmann classification system was used to evaluate the degenerative and intervertebral disc degeneration of fixed unfused segment endplate. SPSS17.0 software was used to analyze and compare the degenerative differences between the two groups of fixed unfused segments. Results the corrected loss values of vertebral wedge angle in group A and group B were 1.42 鹵1.26 and 2.83 鹵2.09, respectively. There was no significant difference between group A and group B after the removal of internal fixation and the preoperative AVHH MVHPVH and vertebral wedge angle. The remaining groups of data were compared, The difference was statistically significant between two groups of patients: P0.05. 2.The difference was statistically significant between the two groups before and after the removal of internal fixation. There was a significant difference between the two groups of patients with non-fused facet joint degeneration before and after the removal of internal fixation. There were significant differences between the two groups of patients without fusion before and after the removal of internal fixation. There was significant difference between the two groups in the degeneration of segmental intervertebral disc. There was significant difference between the two groups before and after the removal of internal fixation. There was significant difference between the two groups in the degeneration of the unfused segmental endplate. One year after short segment internal fixation for lumbar type A fractures, there were different degrees of degeneration in the fixation of unfused segments, as compared with that in the patients with 2 years of internal fixation. However, 1 year after operation and 2 years after the removal of internal fixation can effectively slow down the unfused segment degeneration. Conclusion: the treatment of lumbar type A fractures by posterior short segment internal fixation is satisfactory, and the removal of internal fixation one year after operation can effectively slow down the degeneration of unfused segments.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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