270°融合治疗胸腰段三柱骨折效果观察.doc
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1、270融合治疗胸腰段三柱骨折效果观察The Curative Effect of 270 Degrees Fusion Treatment of Thoracolumbar Fracture with Three Column/JIAO Changming,YU Hong./Chinese and Foreign Medical Research,2018,16(8):8-11 【Abstract】 Objective:To observe the clinical efficacy of the transforaminal interbody bone graft plus contral
2、ateral facet 270 degree fusion in the treatment of thoracolumbar fracture with the three column.Method:From January 2011 to December 2015,using a 270 degree fusion treatment of thoracolumbar fresh in three columns of 87 cases of burst fractures in the posterior decompression and fixation were perfor
3、med on the basis of vertebral transforaminal lumbar interbody fusion of bone grafting plus side joint.The operation time and blood loss were recorded,and the therapeutic effects were evaluated from three aspects,imaging examination,low back pain and nerve function recovery.The lateral X ray to under
4、stand the physiological curvature of the spine,fracture and internal fixation,bone graft fusion with 2D CT.The Cobb angle was measured at 1 week,3 and 12 months.Neurological function was assessed according to ODI score and grade ASIA.Result:The operation time of 87 patients in this group was 135-172
5、 minutes,with an average of 143 minutes.The intraoperative blood loss was 460-780 ml,with an average of 565 ml.All patients were followed up for 12 to 50 months(an average of 35 months).Good fracture reduction and vertebral height recovered satisfactorily after operation,good correction of kyphosis.
6、Preoperative Cobb angle (26.524.23)degrees,the Cobb angle was (3.871.93) at 3 months after operation,and the Cobb angle was (3.952.02) after operation for 12 months,statistically significant difference between before and after surgery(t=26.95,P=0.00).There was no significant difference between 3 mon
7、ths and 12 months after operation(t=1.79,P=0.07).According to the ODI score,the average score was 78 before operation,and the average was 28 after operation.The average improvement rate was about 64.2%.The postoperative ASIA scores were improved in varying degrees.At 12 months after operation,the bo
8、ne graft fusion was obtained by two-dimensional CT,and there was no complication of internal fixation.Conclusion:For patients with fracture of thoracolumbar spine injury in the three column,the screw rod system reset,short or long segment fixation and decompression on the basis of the transforaminal
9、 interbody bone grafting plus contralateral joint reconstruction of vertebral height,capable of correcting the spinal deformity,restore nerve function,maintain the vertebral height and the angle for postoperative patient outcomes,long-term satisfaction.This deserves further clinical promotion. 【Key
10、words】 Thoracolumbar fracture with three column; Fusion; Transforaminal interbody bone grafting First-authors address:Zhushan Peoples Hospital,Zhushan 442200,China 脊柱胸腰段骨折很常见,累及三柱的各种不稳定胸腰椎骨折及脱位的患者也呈增多趋势,合并脊髓及马尾神经损伤会造成患者不同程度的瘫痪。后路椎弓根螺钉复位内固定是目前治疗不稳定性胸腰段骨折最常采用的方法1-3。但是复位固定后绝大部分重力通过内固定物传导,如同四肢骨折一样,内固定的目
11、的是为骨折的愈合及软组织修复创造条件。累及三柱的不稳定性胸腰段骨折骨折常合并终板及椎间盘损伤、后方韧带复合体损伤,骨折复位后常形成的不易愈合“空壳样”椎体,损伤的椎间盘难以修复,后方的减压更增加后柱的不稳定。后期往往造成椎体高度的丢失、椎间隙塌陷、内固定松动断裂等,从而引起腰背疼痛,甚至迟发性瘫痪等后遗症。因此对于累及三柱的严重爆裂性骨折或屈曲牵张型损伤、骨折合并脱位的患者,多数学者建?h在后路钉棒固定术后附加前路支撑及重建4-6。胸腰椎前路重建手术由于创伤较大,稳定性较差,并发症发生率较高,限制了在胸腰椎前路手术中的应用7。经椎间孔入路椎间融合(transforaminal lumbar i
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- 270 融合 治疗 胸腰段三柱 骨折 效果 观察
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