本文選題：胸腰椎骨折 + 間接減壓��； 參考：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:探討單純椎弓根螺釘內(nèi)固定間接減壓治療骨折塊突入椎管30%-50%但無(wú)神經(jīng)癥狀胸腰椎爆裂骨折的手術(shù)效果。方法:選取我院行椎弓根釘內(nèi)固定間接減壓治療骨塊突入椎管無(wú)神經(jīng)損傷癥狀胸腰椎爆裂骨折患者72例。所有患者術(shù)前ASIA分級(jí)均為E級(jí),術(shù)前均完善傷椎正側(cè)位X線片、CT平掃重建、MRI等相關(guān)檢查,X線觀察椎體壓縮性改變并測(cè)量其椎體壓縮率,CT橫截位片觀察有骨折塊突入椎管并測(cè)量椎管侵占率,MRI觀察后縱韌帶連續(xù)性是否存在。根據(jù)CT橫截位片測(cè)量椎管內(nèi)骨塊侵占率分兩組:A組(椎管侵占率0%-29%,n=40)。B組(椎管侵占率30%-50%,n=32)。所有病例均行單純椎弓根螺釘內(nèi)固定間接減壓,通過(guò)隨訪分別記錄兩組術(shù)前、術(shù)后即刻、術(shù)后1月、術(shù)后3月、術(shù)后6月、術(shù)后12月的傷椎后凸Cobb角、椎體壓縮率、椎管侵占率、VAS評(píng)分、ASIA(美國(guó)脊柱損傷協(xié)會(huì))分級(jí)、并發(fā)癥等指標(biāo),觀察兩組病例手術(shù)效果。結(jié)果:兩組病例在年齡、性別、傷椎節(jié)段經(jīng)統(tǒng)計(jì)學(xué)分析,P0.05,無(wú)明顯統(tǒng)計(jì)學(xué)差異。所有患者均獲得隨訪,平均隨訪時(shí)間12.71±1.16個(gè)月,72例患者術(shù)后均未出現(xiàn)神經(jīng)癥狀。A組椎管侵占率由術(shù)前13.82±4.43%恢復(fù)至4.53±1.38%,P0.05;椎體壓縮率由術(shù)前17.37±4.25%恢復(fù)至8.29±3.16%,P0.05;后凸Cobb角由12.17±2.43°恢復(fù)至6.39±1.57°P0.05。B組椎管侵占率由術(shù)前38.48±5.82%恢復(fù)至5.18±1.64%,P0.05;椎體壓縮率由術(shù)前45.55±11.96%恢復(fù)至9.05±3.67%,P0.05;后凸Cobb角由22.71±5.35°矯正至7.29±2.42°P0.05。通過(guò)兩組間t檢驗(yàn)對(duì)比兩組術(shù)后即刻、1月、3月、6月、12月Cobb角、椎體壓縮率、椎管侵占率,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。秩和檢驗(yàn)比較兩組術(shù)前、術(shù)后VAS評(píng)分P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者突入椎管骨折塊復(fù)位滿意,椎管形態(tài)術(shù)后即刻改善良好,隨訪過(guò)程中兩組病例椎管形態(tài)均進(jìn)一步改善,但均未見明顯椎管重塑現(xiàn)象。兩組術(shù)后并發(fā)癥比較:術(shù)后1月時(shí)A組44.68%病例出現(xiàn)椎體高度較術(shù)后即刻丟失及后凸Cobb角增大現(xiàn)象,椎體高度平均丟失2.22%,后凸角平均增大1.28°,術(shù)后一月時(shí)B組46.75%出現(xiàn)椎體高度較術(shù)后即刻丟失及后凸Cobb較增大,椎體高度平均丟失3.14%,后凸角平均增大1.09°。繼續(xù)隨訪至術(shù)后1年,未見椎體高度繼續(xù)丟失及后凸角度繼續(xù)增大。A組術(shù)后并發(fā)癥中,出現(xiàn)切口延遲愈合3例,未見其他術(shù)后并發(fā)癥。B組術(shù)后并發(fā)癥出現(xiàn)切口延遲愈合3例,椎體蛋殼樣改變1例,椎體真空征1例,兩組比較,B組術(shù)后并發(fā)癥發(fā)生率較高。結(jié)論:1.單純內(nèi)固定間接減壓治療骨折塊突入椎管30%-50%無(wú)神經(jīng)癥狀的胸腰椎爆裂骨折療效滿意。2.胸腰段骨折術(shù)后短期內(nèi)易出現(xiàn)椎體高度少量丟失及傷椎后凸Cobb輕度增大。
[Abstract]:Objective: to investigate the effect of indirect decompression with pedicle screw fixation in the treatment of thoracolumbar burst fracture with 30-50% vertebral canal penetration without nerve symptoms. Methods: 72 cases of thoracolumbar burst fracture without nerve injury symptom were treated with indirect decompression with pedicle nail in our hospital. Before operation, Asia grade was grade E in all patients. Ct plain scan and MRI were all perfect before operation to observe the changes of vertebral compression and measure the compression rate of vertebral body. Ct transverse section film was used to observe the fracture mass into the spinal canal and measure the invasion rate of the spinal canal. Whether or not the continuity of the posterior longitudinal ligament exists. According to CT transection, the intraspinal invasion rate of bone mass was divided into two groups: group A (0 -29%) and group B (30% -50%). All cases were treated with indirect decompression with pedicle screw fixation. The Cobb angle and compression ratio of injured vertebral kyphosis were recorded before, immediately, 1 month, 3 months, 6 months after operation and 12 months after operation, respectively. The vertebral canal invasion rate (VAS) score, ASIA (American Spinal injury Association) classification, complications and other indicators were observed in the two groups. Results: there was no significant difference between the two groups in age, sex and injured vertebral segment (P 0.05). All patients were followed up. The average follow-up time was 12.71 鹵1.16 months. The spinal canal invasion rate of group A recovered from 13.82 鹵4.43% to 4.53 鹵1.38 P0.05, the vertebral compression rate recovered from 17.37 鹵4.25% to 8.29 鹵3.16% P0.05, and the Cobb angle of kyphosis recovered from 12.17 鹵2.43 擄to 6.39 鹵1.57 擄P0.05.B after operation, the spinal canal invasion rate of group A recovered from 13.82 鹵4.43% to 4.53 鹵1.38%, from 17.37 鹵4.25% to 8.29 鹵3.16 擄P0.05, and the Cobb angle of kyphosis recovered from 12.17 鹵2.43 擄to 6.39 鹵1.57 擄P0.05.B 38.48 鹵5.82% recovered to 5.18 鹵1.64% P 0.05, vertebral compression rate recovered from 45.55 鹵11.96% to 9.05 鹵3.67 P 0.05, kyphosis Cobb angle corrected from 22.71 鹵5.35 擄to 7.29 鹵2.42 擄P 0.05. There was no significant difference in Cobb angle, vertebral compression ratio and spinal canal invasion rate between the two groups immediately, 1 month, 3 months, 6 months and 12 months after operation by t test. There was no significant difference in VAS score between the two groups before and after operation by rank sum test (P 0.05). The two groups of patients were satisfied with the reduction of the vertebral canal fracture and the morphology of the vertebral canal was improved immediately after the operation. During the follow-up the morphology of the vertebral canal was further improved in both groups but there was no obvious phenomenon of vertebral canal remodeling. Comparison of postoperative complications between the two groups: 44.68% of the patients in group A had lost vertebral body height and increased Cobb angle of kyphosis at one month after operation. The average loss of vertebral height and kyphoid angle were 2.222.22 and 1.28 擄respectively. At one month after operation, 46.75% of the patients in group B had higher height of vertebral body than that of immediate loss and Cobb of kyphosis. The average loss of height of vertebral body and kyphoid angle were 3.14 and 1.09 擄respectively. In group A, there were 3 cases of delayed healing of incision and 3 cases of delayed healing of incision in group B. there were 3 cases of delayed healing of incision in group B and 3 cases of delayed healing of incision in group A. The incidence of postoperative complications in group B was higher than that in group B. Conclusion 1. Treatment of 30-50% thoracolumbar burst fracture without neurological symptoms by indirect decompression with internal fixation was satisfactory. After thoracolumbar fracture, a little loss of vertebral height and a slight increase of Cobb in injured vertebral kyphosis occurred in short term.
【學(xué)位授予單位】：石河子大學(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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