Denis B型胸腰椎爆裂性骨折行后路单节段钛网重建术对邻近节段的影响
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摘要
目的探讨Denis B型胸腰椎爆裂性骨折行后路单节段钛网重建术对邻近节段的影响。方法 20例Denis B型胸腰椎爆裂性骨折患者行后路单侧椎体次全切除、脊髓270°减压、钛网植骨重建前中柱及椎弓根钉内固定并后路重建术。1年后取出钉棒内固定并继续随访1～3年。末次随访通过动力位X线片、MRI评估邻近节段椎间盘变化情况。结果末次随访时,患者钛网均无松动。有2例患者出现不同程度塌陷,Cobb角有所丢失。所有患者远端椎间盘有不同程度退变,椎间隙未见明显变窄,邻近节段椎间盘退变Pfirrmann分级:Ⅰ级退变13例,Ⅱ级退变5例,Ⅲ级退变1例,Ⅳ级退变1例。结论后路单节段固定钛网重建治疗Denis B型胸腰椎爆裂性骨折加速邻近节段椎间盘退行性变。
Objective To evaluate the effect on adjacent segment by posterior single-segment decompression and reconstruction for treatment of Denis type B thoracolumbar burst fractures. Methods The 20 patients with Denis type B thoracolumbar burst fractures were treated with unilateral subtotal vertebraectomy with the posterior approach,270°decompression,titanium mesh supporting bone autograft for reconstruction of the anterior and middle columns,pedicle screw fixation,and the posterior construction. The screw-rod was removed at 1 year after surgery and continued to gain 1 ～ 3 years follow-up. The change of adjacent segment intervertebral disc was evaluated by power position X-ray film and MRI at the last follow-up. Results At last follow-up,no titanium mesh loosening occurred. There were different degrees collapse in 2 cases,Cobb angel had a litte loss,all cases of the distal intervertebral disc had different degree degeneration,there wasn't significant narrowing of the intervertebral space. Pfirrmann grading of adjacent segment intervertebral disc degeneration: degreeⅠdegeneration was in 13 cases,degree Ⅱ 5 cases,degree Ⅲ 1,degreeⅣ 1. Conclusions The operation of posterior single-segment fusion for the treatment of Denis type B thoracolumbar burst fractures accelerates adjacent segment degeneration.
Objective To evaluate the effect on adjacent segment by posterior single-segment decompression and reconstruction for treatment of Denis type B thoracolumbar burst fractures. Methods The 20 patients with Denis type B thoracolumbar burst fractures were treated with unilateral subtotal vertebraectomy with the posterior approach,270°decompression,titanium mesh supporting bone autograft for reconstruction of the anterior and middle columns,pedicle screw fixation,and the posterior construction. The screw-rod was removed at 1 year after surgery and continued to gain 1 ～ 3 years follow-up. The change of adjacent segment intervertebral disc was evaluated by power position X-ray film and MRI at the last follow-up. Results At last follow-up,no titanium mesh loosening occurred. There were different degrees collapse in 2 cases,Cobb angel had a litte loss,all cases of the distal intervertebral disc had different degree degeneration,there wasn't significant narrowing of the intervertebral space. Pfirrmann grading of adjacent segment intervertebral disc degeneration: degreeⅠdegeneration was in 13 cases,degree Ⅱ 5 cases,degree Ⅲ 1,degreeⅣ 1. Conclusions The operation of posterior single-segment fusion for the treatment of Denis type B thoracolumbar burst fractures accelerates adjacent segment degeneration.
引文
[1]柯国柱,胡立生.腰椎后路椎间融合术对邻近节段退行性变的影响分析[J].医学理论与实践,2015,28(20):2789-2790.
[2]胡枫,张文志,李旭,等.微创与开放经椎间孔腰椎间融合术后邻近节段退变的比较[J].临床骨科杂志,2017,20(3):257-261.
[2]胡枫,张文志,李旭,等.微创与开放经椎间孔腰椎间融合术后邻近节段退变的比较[J].临床骨科杂志,2017,20(3):257-261.