長(zhǎng)期固定對(duì)胸腰段關(guān)節(jié)突關(guān)節(jié)影響的研究
發(fā)布時(shí)間：2019-07-09 18:37
【摘要】：目的：胸腰段是固定的胸椎與活動(dòng)的腰椎之間的轉(zhuǎn)換點(diǎn),是胸椎生理后突與腰椎生理前凸銜接點(diǎn),是關(guān)節(jié)突關(guān)節(jié)面朝向的移行,是軀干活動(dòng)應(yīng)力、肩背負(fù)重應(yīng)力的集中點(diǎn),因此胸腰段也就成為了脊柱骨折的好發(fā)部位[1]。在高能量損傷中胸腰段骨折占有較大比例,目前常用技術(shù)為椎弓根螺釘內(nèi)固定系統(tǒng)。探討胸腰段骨折中椎弓根固定系統(tǒng)的影響有著重要意義。本文意在探討脊柱胸腰段骨折后行單純椎弓根螺釘固定(大于1年),長(zhǎng)期固定因素(大于1年)對(duì)胸腰段關(guān)節(jié)突關(guān)節(jié)的影響。方法：回顧分析病歷,自2012年7月至2014年12月29個(gè)月內(nèi)51例病人。其中男性35例,女性16例,年齡21-57歲,平均年齡39.42±9.63歲。這些病人,受傷部位為胸腰段,骨折類(lèi)型為壓縮骨折、沒(méi)有后柱損傷的爆裂骨折、椎管占位1/3、沒(méi)有神經(jīng)損傷、Frankle/ASIA[2]分級(jí)為E級(jí)。這些病人具備手術(shù)指征,[3,4]同時(shí)可以腰椎后路單純椎弓根螺釘固定術(shù)。受傷當(dāng)時(shí)關(guān)節(jié)突關(guān)節(jié)無(wú)退行性變化,骨折不累及關(guān)節(jié)突關(guān)節(jié),經(jīng)肌間隙入路行單純螺釘固定術(shù),術(shù)中操作不對(duì)關(guān)節(jié)突關(guān)節(jié)造成影響。這些病人經(jīng)長(zhǎng)期(大于1年)單純椎弓根螺釘固定術(shù)后,再次經(jīng)肌間隙入路,不影響關(guān)節(jié)突關(guān)節(jié),取出椎弓根固定裝置。內(nèi)固定裝置取出術(shù)后,給予常規(guī)康復(fù)鍛煉、護(hù)理,患者手術(shù)切口疼痛不重時(shí)行胸腰段過(guò)伸-過(guò)屈位X線檢查,通過(guò)測(cè)量胸腰段過(guò)伸位被固定椎體矢狀位Cobb角、胸腰段過(guò)屈位固定范圍內(nèi)的矢狀位Cobb角,通過(guò)配對(duì)t檢驗(yàn),評(píng)估矢狀面上固定范圍內(nèi)關(guān)節(jié)突關(guān)節(jié)的活動(dòng)度。通過(guò)CT分別從矢狀面、水平面、冠狀面掃面、觀察固定范圍內(nèi)的關(guān)節(jié)突關(guān)節(jié),CT掃描厚度為1.2mm,掃描范圍包含了被固定關(guān)節(jié)突關(guān)節(jié)。并與固定范圍內(nèi)關(guān)節(jié)突關(guān)節(jié)相臨近的未被固定的關(guān)節(jié)突關(guān)節(jié)對(duì)比,通過(guò)關(guān)節(jié)突突關(guān)節(jié)關(guān)節(jié)間隙狹窄、關(guān)節(jié)突關(guān)節(jié)是否有完整骨痂形成、關(guān)節(jié)間隙是否中斷三個(gè)方面評(píng)估長(zhǎng)期固定因素對(duì)關(guān)節(jié)突關(guān)節(jié)的影響�；仡櫜榭词軅蠡颊呓�(jīng)單純椎弓根螺釘內(nèi)固定術(shù),術(shù)后經(jīng)過(guò)2個(gè)月康復(fù),于門(mén)診復(fù)查,行VAS評(píng)分、ODI評(píng)分(Oswestry評(píng)分),內(nèi)固定取除術(shù)后經(jīng)1.5個(gè)月至2個(gè)月的康復(fù)鍛煉、護(hù)理,再次行VAS評(píng)分、IDO評(píng)分(Oswestry評(píng)分),對(duì)比內(nèi)固定術(shù)后的VAS評(píng)分?jǐn)?shù)值、ODI評(píng)分?jǐn)?shù)值(Oswestry評(píng)分),用以評(píng)價(jià)長(zhǎng)期固定(大于1年)因素對(duì)關(guān)節(jié)突關(guān)節(jié)影響在臨床癥狀方面的表現(xiàn)。結(jié)果：矢狀位動(dòng)態(tài)X線檢查,分別測(cè)得的固定范圍內(nèi)椎體過(guò)伸位Cobb角,過(guò)屈位Cobb角,進(jìn)行配對(duì)t檢驗(yàn),得出P0.05,矢狀面上固定范圍內(nèi)椎體過(guò)伸位Cobb角與過(guò)屈位Cobb角無(wú)統(tǒng)計(jì)學(xué)差異。CT檢查,以單個(gè)關(guān)節(jié)突關(guān)節(jié)為觀察對(duì)象,關(guān)節(jié)突關(guān)節(jié)關(guān)節(jié)間隙狹窄75.49%,關(guān)節(jié)間隙連續(xù)性中斷10.29%,完整骨痂形成1.47%。內(nèi)固定術(shù)后2月VAS評(píng)分,平均2.39±1.36分,取出椎弓根螺釘固定裝置2個(gè)月后VAS評(píng)分,平均2.27±1.42分,二者沒(méi)有統(tǒng)計(jì)學(xué)差異。取出固定裝置后2個(gè)月ODI評(píng)分,平均6.64%±5.26%,功能評(píng)價(jià)優(yōu)良率100%。結(jié)論：長(zhǎng)期(大于1年)固定后關(guān)節(jié)突關(guān)節(jié)沒(méi)有達(dá)到骨性融合,但仍造成關(guān)節(jié)突關(guān)節(jié)活動(dòng)度消失。這種改變并不會(huì)引起明顯的臨床癥狀,也不會(huì)影響整體功能。
文內(nèi)圖片：
圖片說(shuō)明：圖２ａ邋４２歲中年男性，受傷時(shí)間２０１１年１０月，傷椎為第２腰椎，，固定節(jié)段為逡逑
[Abstract]:Objective: The thoracolumbar segment is the transition point between the fixed thoracic and the active lumbar vertebra. It is the point of connection between the back and the back of the thoracic and lumbar vertebrae. It is the migration of the articular surface of the joint. It is the central point of the stress of the trunk and the heavy stress on the shoulder. Therefore, the thoracolumbar segment also becomes a good position of the fracture of the spinal column[1]. In that high-energy injury, the thoracolumbar fracture occupy a large proportion, and the common technique is the internal fixation system of the pedicle screw. It is of great significance to study the effect of the pedicle fixation system in the thoracolumbar fracture. The purpose of this study is to study the effect of simple pedicle screw fixation (more than 1 year) and long-term fixation (more than 1 year) on the joint of the thoracolumbar segment after the fracture of the thoracolumbar spine. Methods: The medical records were reviewed and 51 patients were from July 2012 to December 29,2014. Among them,35 were male,16 female,21-57 years old, and the mean age was 39.42 and 9.63 years. These patients, the injured part is the thoracolumbar section, the fracture type is the compression fracture, the burst fracture with no post-post injury, the spinal canal space is 1/3, no nerve damage, the Frankle/ AIA[2] is grade E. The patients had an indication of surgery,[3,4], while the lumbar posterior pedicle screw fixation could be performed at the same time. At that time, there was no degenerative changes in the articular process of the articular process, and the fracture did not involve the joint of the articular process. After the patients had been fixed with the pedicle screw for a long time (more than 1 year), the joint of the articular process was not affected, and the pedicle fixation device was taken out without affecting the joint of the joint. After the internal fixation device is taken out, the routine rehabilitation exercise and the nursing are performed, and the chest and waist section through-extension-over-flexion X-ray examination is performed when the pain of the surgical incision of the patient is not heavy, the sagittal Cobb angle of the sagittal position Cobb of the vertebral body is fixed by measuring the over-extension position of the thoracolumbar section, and the sagittal Cobb angle in the flexion-position fixing range of the thoracolumbar section is fixed, The range of motion of the articular process joints on the sagittal plane was evaluated by the paired t-test. The CT scan thickness was 1.2 mm from the sagittal plane, the horizontal plane and the coronal plane through the CT, and the scan range included the fixed articular process joint. And the effect of the long-term fixation factors on the articular process joint is evaluated through the three aspects of whether the joint gap is narrow, the joint process joint has a complete bone formation, and whether the joint gap is interrupted or not is compared with the non-fixed joint process joint adjacent to the joint process joint in the fixed range. It was reviewed that the patients with post-injury underwent a simple pedicle screw internal fixation, and the patients were recovered after 2 months after the operation, and the VAS score and the ODI score (Oswestry score) were performed in the out-patient clinic, and the recovery exercise, nursing and the VAS score after 1.5 months to 2 months after the operation were fixed in the internal fixation. The score of the IDO score (Oswestry score), the VAS score value after the internal fixation, and the ODI score value (Oswestry score) were used to evaluate the performance of long-term fixation (more than 1 year) on the effect of long-term fixation (more than 1 year) on the clinical symptoms of the articular process. Results: The Cobb angle and the Cobb angle of the body in the fixed range were measured by the sagittal dynamic X-ray examination. The Cobb angle and the Cobb angle of the over-flexion position were not statistically different from the angle of Cobb in the fixed range of the sagittal plane. The results showed that the joint space of the joint was 75.49%, the continuity of the joint was 10.29%, and the total bone rate was 1.47%. The VAS score was 2.39 and 1.36 points after the internal fixation, and the VAS score after 2 months after the fixation of the pedicle screw was taken out, with an average of 2.27 and 1.42 points, and there was no statistical difference between them. The score of ODI in 2 months after removal of the fixation device was 6.64% and 5.26%, and the excellent and good rate was 100%. Conclusion: In the long-term (more than one year), the joint of the articular process does not reach the bony fusion, but still causes the joint movement of the joint to disappear. This change does not cause significant clinical symptoms and does not affect the overall function.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3
本文編號(hào)：2512360
文內(nèi)圖片：
圖片說(shuō)明：圖２ａ邋４２歲中年男性，受傷時(shí)間２０１１年１０月，傷椎為第２腰椎，，固定節(jié)段為逡逑
[Abstract]:Objective: The thoracolumbar segment is the transition point between the fixed thoracic and the active lumbar vertebra. It is the point of connection between the back and the back of the thoracic and lumbar vertebrae. It is the migration of the articular surface of the joint. It is the central point of the stress of the trunk and the heavy stress on the shoulder. Therefore, the thoracolumbar segment also becomes a good position of the fracture of the spinal column[1]. In that high-energy injury, the thoracolumbar fracture occupy a large proportion, and the common technique is the internal fixation system of the pedicle screw. It is of great significance to study the effect of the pedicle fixation system in the thoracolumbar fracture. The purpose of this study is to study the effect of simple pedicle screw fixation (more than 1 year) and long-term fixation (more than 1 year) on the joint of the thoracolumbar segment after the fracture of the thoracolumbar spine. Methods: The medical records were reviewed and 51 patients were from July 2012 to December 29,2014. Among them,35 were male,16 female,21-57 years old, and the mean age was 39.42 and 9.63 years. These patients, the injured part is the thoracolumbar section, the fracture type is the compression fracture, the burst fracture with no post-post injury, the spinal canal space is 1/3, no nerve damage, the Frankle/ AIA[2] is grade E. The patients had an indication of surgery,[3,4], while the lumbar posterior pedicle screw fixation could be performed at the same time. At that time, there was no degenerative changes in the articular process of the articular process, and the fracture did not involve the joint of the articular process. After the patients had been fixed with the pedicle screw for a long time (more than 1 year), the joint of the articular process was not affected, and the pedicle fixation device was taken out without affecting the joint of the joint. After the internal fixation device is taken out, the routine rehabilitation exercise and the nursing are performed, and the chest and waist section through-extension-over-flexion X-ray examination is performed when the pain of the surgical incision of the patient is not heavy, the sagittal Cobb angle of the sagittal position Cobb of the vertebral body is fixed by measuring the over-extension position of the thoracolumbar section, and the sagittal Cobb angle in the flexion-position fixing range of the thoracolumbar section is fixed, The range of motion of the articular process joints on the sagittal plane was evaluated by the paired t-test. The CT scan thickness was 1.2 mm from the sagittal plane, the horizontal plane and the coronal plane through the CT, and the scan range included the fixed articular process joint. And the effect of the long-term fixation factors on the articular process joint is evaluated through the three aspects of whether the joint gap is narrow, the joint process joint has a complete bone formation, and whether the joint gap is interrupted or not is compared with the non-fixed joint process joint adjacent to the joint process joint in the fixed range. It was reviewed that the patients with post-injury underwent a simple pedicle screw internal fixation, and the patients were recovered after 2 months after the operation, and the VAS score and the ODI score (Oswestry score) were performed in the out-patient clinic, and the recovery exercise, nursing and the VAS score after 1.5 months to 2 months after the operation were fixed in the internal fixation. The score of the IDO score (Oswestry score), the VAS score value after the internal fixation, and the ODI score value (Oswestry score) were used to evaluate the performance of long-term fixation (more than 1 year) on the effect of long-term fixation (more than 1 year) on the clinical symptoms of the articular process. Results: The Cobb angle and the Cobb angle of the body in the fixed range were measured by the sagittal dynamic X-ray examination. The Cobb angle and the Cobb angle of the over-flexion position were not statistically different from the angle of Cobb in the fixed range of the sagittal plane. The results showed that the joint space of the joint was 75.49%, the continuity of the joint was 10.29%, and the total bone rate was 1.47%. The VAS score was 2.39 and 1.36 points after the internal fixation, and the VAS score after 2 months after the fixation of the pedicle screw was taken out, with an average of 2.27 and 1.42 points, and there was no statistical difference between them. The score of ODI in 2 months after removal of the fixation device was 6.64% and 5.26%, and the excellent and good rate was 100%. Conclusion: In the long-term (more than one year), the joint of the articular process does not reach the bony fusion, but still causes the joint movement of the joint to disappear. This change does not cause significant clinical symptoms and does not affect the overall function.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3
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