伤椎椎体内撬拨治疗胸腰椎骨折的手术技巧及临床疗效

张波华; 蔡金生; 赵永飞; 吴占勇; 吴华荣; 张连锁; 徐伟坤; 王会旺; 范会龙; 路鑫铭; 马建青; 杨圣

doi:10.3969/j.issn.2095-5227.2018.04.012

伤椎椎体内撬拨治疗胸腰椎骨折的手术技巧及临床疗效

Surgical techniques and clinical effect of poking reduction in treatment of thoracolumbar fracture

摘要

摘要: 目的探讨伤椎置钉、椎体内撬拨治疗胸腰椎骨折的手术技巧及临床疗效。方法回顾性分析2012年1月-2015年1月邢台市骨科医院收治的行该后路手术的胸腰椎骨折患者71例，采用不同角度、不同深度伤椎置钉、伤椎内撬拨、分别撑开复位的手术技巧并评估其临床疗效（椎体前高压缩比、COBB角、JOA评分）。结果所有患者随访1年，未发现严重并发症。椎体前高压缩比：术前63.3%±20.1%，术后1年97.7%±1.7%；COBB角：术前27.3°±2.4°，术后1年5.5°±1.7°；JOA评分：术前16.5±3.1，术后1年27.8±1.1，统计学分析发现三项评价指标均较术前明显改善（P均< 0.05）。结论独创的不同角度、不同深度伤椎置钉、分别撬拨、撑开、复位的术中操作技术，简单有效，能够取得良好的临床疗效。

Abstract: Objective To discuss the surgical techniques and clinical effect of poking reduction in treatment of thoracolumbar fracture. Methods Clinical data about 71 patients with thoracolumbar fracture admitted to Orthopedic Hospital of Xingtai City from January 2012 to January 2015 who were treated with this technique were reviewed and analyzed. Nails were implanted into the injured vertebras at different angel and in different depth for poking reduction. Clinical effects including the compression ratio of anterior vertebral height, COBB angel and JOA score were evaluated. Results All patients were followed up for one year and no serious complication was found. The compression ratio of anterior vertebral height, COBB angel and JOA score increased significantly (compression ratio of anterior vertebral height, 97.7%±1.7% vs 63.3%±20.1%; COBB angel, 27.3°±2.4° vs 5.5°±1.7°; JOA, 27.8±1.1 vs 16.5±3.1; all P < 0.05). Conclusion Implanting nail at different angel and in different depth to poke, stretch and restore injured vertebras is a unique, simple and effective treatment for thoracolumbar fracture with favourable clinical outcomes.

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