【摘要】：胸腰段骨折是最常見(jiàn)的脊柱損傷。胸腰段骨折容易導(dǎo)致神經(jīng)功能損傷,這就使它的治療更加重要和困難。胸腰段骨折也常伴隨著椎間盤(pán)的損傷,導(dǎo)致運(yùn)動(dòng)節(jié)段高度的丟失、脊柱后凸畸形。隨著影像學(xué)和生物力學(xué)的發(fā)展、內(nèi)固定器械和手術(shù)技巧的改進(jìn),胸腰段骨折的治療已取得很大進(jìn)展,但仍然存在爭(zhēng)議。椎間盤(pán)是維持脊柱穩(wěn)定性以及活動(dòng)節(jié)段高度的一個(gè)重要結(jié)構(gòu)。胸腰椎骨折常伴有臨位椎間盤(pán)的損傷,椎間盤(pán)損傷的形式以及愈合的方式都會(huì)對(duì)骨折術(shù)后脊柱的穩(wěn)定性產(chǎn)生影響。而傳統(tǒng)后入路短節(jié)段內(nèi)固定術(shù)常常對(duì)于椎間盤(pán)不予處理,這有可能是造成骨折術(shù)后脊柱運(yùn)動(dòng)節(jié)段高度丟失、后凸畸形的一個(gè)重要因素。因此,術(shù)前對(duì)于椎間盤(pán)損傷的評(píng)估對(duì)于手術(shù)方案的制定具有重要的意義。選取2014.9-2016.2于我院就診并行后入路內(nèi)固定術(shù)的胸腰段骨折患者,共20例,年齡20~50歲,平均33.5歲。分別于術(shù)前、術(shù)后、術(shù)后12個(gè)月、取內(nèi)固定術(shù)后、取內(nèi)固定術(shù)后6個(gè)月進(jìn)行隨訪,獲得其X線、MRI影像資料。根據(jù)患者術(shù)前MRI對(duì)其椎間盤(pán)損傷程度、椎體損傷程度、終板損傷程度進(jìn)行分級(jí),同時(shí)對(duì)各個(gè)隨訪點(diǎn)的患者在X線上測(cè)量椎間隙高度并對(duì)數(shù)據(jù)進(jìn)行分析,平均隨訪14.1月。其中A1型骨折16例,A3型骨折4例;傷椎位于T11椎體2例,位于T12椎體10例,位于L1椎體3例,位于L2椎體5例。目前臨床使用的的內(nèi)固定器材對(duì)于解除神經(jīng)壓迫、解除椎管致壓物、恢復(fù)椎體高度及形態(tài)等的技術(shù)已相對(duì)成熟,但是目前對(duì)于胸腰段爆裂骨折特別是不伴有神經(jīng)功能損傷的患者,在手術(shù)與非手術(shù)、融合與非融合上,仍然存在著很大的爭(zhēng)議。在觀察患者影像學(xué)資料后我們發(fā)現(xiàn),I、II型椎間盤(pán)損傷椎間高度在術(shù)前差距不大,而III、IV型椎間高度明顯下降。術(shù)前有椎間盤(pán)損傷患者,骨折愈合取內(nèi)固定術(shù)后椎間高度的丟失率明顯比無(wú)椎間盤(pán)損傷的患者高。而且這個(gè)椎間高度丟失率與術(shù)前椎間盤(pán)損傷程度有關(guān),且III、IV型椎間盤(pán)損傷患者其術(shù)后椎間高度丟失率明顯高于I、II型患者。患者椎間盤(pán)損傷程度與椎體損傷程度以及終板損傷程度呈正相關(guān)�？梢钥闯�,骨折伴椎間盤(pán)的損傷會(huì)導(dǎo)致內(nèi)固定術(shù)后患者椎間隙的塌陷以及運(yùn)動(dòng)節(jié)段高度的丟失。因此,為了防止由椎間盤(pán)損傷所帶來(lái)的運(yùn)動(dòng)節(jié)段高度丟失以及脊柱不穩(wěn)的問(wèn)題,就需要清除間盤(pán)組織,并進(jìn)行牢固的椎間融合。
[Abstract]:Thoracolumbar fracture is the most common spinal injury. It is more important and difficult for the treatment of the thoracolumbar fracture to result in a neurological deficit. The thoracolumbar fracture is often accompanied by the injury of the disc, resulting in the loss of the height of the motion segment, and the kyphosis of the spine. With the development of image and biomechanics, the improvement of internal fixation device and surgical technique, the treatment of thoracolumbar fracture has made great progress, but there is still a dispute. The disc is an important structure to maintain the stability of the spine and the height of the active segment. Thoracolumbar fracture is often associated with the injury of the spinal disc, the form of disc injury and the way of healing can have an effect on the stability of the spinal column after the fracture. The internal fixation of the traditional posterior segment of the posterior segment is often not treated for the disc, which may be an important factor in the highly lost and kyphosis of the spinal motion segment after the fracture. Therefore, the preoperative evaluation of the disc injury is of great significance to the development of the operation plan. A total of 20 cases of thoracolumbar fracture with internal fixation with internal fixation of 2014.9-2016.2 in our hospital were selected, with a mean age of 20-50 years and an average of 33.5 years. The X-ray and MRI image data were obtained by follow-up for 6 months after the internal fixation and the internal fixation. The degree of disc injury, the degree of damage of the vertebral body and the degree of endplate injury were graded according to the pre-operative MRI of the patient, and the height of the intervertebral space was measured on the X-ray by the patients at each follow-up point and the data were analyzed, with an average follow-up of 14.1 months. Among them, there were 16 cases of type A1 fracture and 4 cases of A3 type fracture. The injured vertebra was located in 2 cases of T11 vertebral body,10 in the T12 vertebral body,3 in the L1 vertebral body and 5 in the L2 vertebral body. The internal fixation device used in clinical use is relatively mature for the technique of releasing the nerve compression, releasing the vertebral canal pressure, restoring the height and the shape of the vertebral body, etc., but at present, for patients with the thoracolumbar burst fracture, in particular without the nerve function injury, in the operation and the non-operation, There is still a great deal of controversy over the integration and non-fusion. We found that the intervertebral height of type I and type II disc injury was not large before the operation, and the height of type III and IV was significantly lower after the observation of the imaging data of the patient. In patients with disc injury, the rate of loss of intervertebral height after fracture healing was significantly higher than that of patients without disc injury. And the loss rate of the intervertebral height is related to the degree of the pre-operative disc injury, and the loss rate of the postoperative intervertebral height of the patients with type III and IV disc injury is significantly higher than that of the I and II patients. The degree of disc injury in the patient was positively correlated with the degree of vertebral body injury and the degree of damage to the endplates. It can be seen that the injury of the fracture with the disc can lead to the collapse of the intervertebral space and the loss of the height of the motion segment after the internal fixation. Therefore, in order to prevent the loss of the height of the motion segment caused by the disc injury and the problem of spinal instability, it is necessary to clear the tissue of the intervertebral disc and make a firm intervertebral fusion.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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