椎弓根螺钉系统在胸腰椎地震伤病员中的应用
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摘要
目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70~115分钟,平均出血量约280 mL,两例病员术中出血超过400 mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3~7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
Objective: To investigate clinical results and features of pedicle screw fixation in treatment of thoracic and lumbar fractures in patients resulting from earthquake.Methods: 19 patients with thoracic or lumbar fracture were treated with short-segment pedicle screw fixation and reduction.Results: The time of operation is about 70~115 minutes.The average blooding volume is 280ml and 2 patients whose blood volume is beyond 400ml receive blood transfusion.There are significant differences in the kyphotic Cobb angle and ratio of anterior vertebral height between their postoperative and preoperative radiological measurements.The patients are transported to other hospitals in cities unaffected by earthquake 3~7 days after operation.The scale of Frankel is improvement by 0.4.Conclusions: The technique of pedicle screw system has the advantages of saving time and medical materials,increasing the efficiency of treatment,and relieving the syptoms of the patients.This technique is suitable for emergency treatment of a large number of patients in a short time.
Objective: To investigate clinical results and features of pedicle screw fixation in treatment of thoracic and lumbar fractures in patients resulting from earthquake.Methods: 19 patients with thoracic or lumbar fracture were treated with short-segment pedicle screw fixation and reduction.Results: The time of operation is about 70~115 minutes.The average blooding volume is 280ml and 2 patients whose blood volume is beyond 400ml receive blood transfusion.There are significant differences in the kyphotic Cobb angle and ratio of anterior vertebral height between their postoperative and preoperative radiological measurements.The patients are transported to other hospitals in cities unaffected by earthquake 3~7 days after operation.The scale of Frankel is improvement by 0.4.Conclusions: The technique of pedicle screw system has the advantages of saving time and medical materials,increasing the efficiency of treatment,and relieving the syptoms of the patients.This technique is suitable for emergency treatment of a large number of patients in a short time.
引文
[1]WEINSTEIN J N,SPRATT K F,SPENGLER D,et al.Spinalpedicle fixation:reliability and validity of roentgenogram-based as-sessment and surgical factors on successful screw placement[J].Spine,1988,13:1012.
[2]BAY B K,YERBY S A,MCLAIN R F,et al.Measurement ofstrain distributions within vertebral body sections by texture corre-lation[J].Spine,1999;24(1):10-17.
[3]SCHNEE C L,ANSELL L V.Selection criteria and outcome of op-erative approachers for thoracolumbar burst fractures with andwithout neurological deficit[J].J Neurosurg,1997,86:48-55.
[4]陈梓锋,郭延杰,林斌,等.前路减压、钛网支撑植骨、Z-Plate钢板内固定治疗陈旧性胸腰段脊柱骨折[J].临床骨科杂志,2005,8(4):304-306.
[5]ROY-CAMILLE R,SAILANT G,MAZZEL C.Internal fixationof the lumbar spine with pedicle screw plating[J].Clin Orthop1986;203:7-17.
[6]CHEN S I,LIN R M,CHANG C H.Biomechanical investigationof pedicle screw-vertebrae complex:a finite element approach usingbonded and contact interface conditions[J].Medical Engineering&Physics 2003,25:275-282.
[7]肖宇龙,霍洪军,杨学军.胸腰椎骨折椎弓根内固定治疗的疗效评定[J].中华创伤骨科杂志,2004,6:1287-1288.
[8]朱军,李云飞,李慧章.伸展体位与短节段椎弓根螺钉治疗胸腰椎爆裂性骨折[J].临床骨科杂志,2004:7(2),171-173.
[9]CHEN C S,CHEN W J,CHENG C K,et al.Failure analysis ofbroken pedicle screws on spinal instrumentation[J].Medical Engi-neering&Physics,2005,27:487-496.
[2]BAY B K,YERBY S A,MCLAIN R F,et al.Measurement ofstrain distributions within vertebral body sections by texture corre-lation[J].Spine,1999;24(1):10-17.
[3]SCHNEE C L,ANSELL L V.Selection criteria and outcome of op-erative approachers for thoracolumbar burst fractures with andwithout neurological deficit[J].J Neurosurg,1997,86:48-55.
[4]陈梓锋,郭延杰,林斌,等.前路减压、钛网支撑植骨、Z-Plate钢板内固定治疗陈旧性胸腰段脊柱骨折[J].临床骨科杂志,2005,8(4):304-306.
[5]ROY-CAMILLE R,SAILANT G,MAZZEL C.Internal fixationof the lumbar spine with pedicle screw plating[J].Clin Orthop1986;203:7-17.
[6]CHEN S I,LIN R M,CHANG C H.Biomechanical investigationof pedicle screw-vertebrae complex:a finite element approach usingbonded and contact interface conditions[J].Medical Engineering&Physics 2003,25:275-282.
[7]肖宇龙,霍洪军,杨学军.胸腰椎骨折椎弓根内固定治疗的疗效评定[J].中华创伤骨科杂志,2004,6:1287-1288.
[8]朱军,李云飞,李慧章.伸展体位与短节段椎弓根螺钉治疗胸腰椎爆裂性骨折[J].临床骨科杂志,2004:7(2),171-173.
[9]CHEN C S,CHEN W J,CHENG C K,et al.Failure analysis ofbroken pedicle screws on spinal instrumentation[J].Medical Engi-neering&Physics,2005,27:487-496.
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