胸腰椎骨折脱位经后路长节段内固定术后力线不良及其原因分析

doi:10.13418/j.issn.1001-165x.2017.01.017

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (1): 85-89.doi: 10.13418/j.issn.1001-165x.2017.01.017

胸腰椎骨折脱位经后路长节段内固定术后力线不良及其原因分析

王翔，　蔡毅，　郑明辉，　瞿东滨

南方医科大学南方医院脊柱骨科，广州 510515

收稿日期:2016-09-01 出版日期:2017-01-25 发布日期:2017-02-22
通讯作者: 瞿东滨，主任医师，教授，博士生导师, E-mail:nfyy_qu@163.com
作者简介:王翔（1990-），男，湖北孝感人，在读硕士，研究方向：脊柱外科，Tel:15626463988，E-mail: yjswx2015@163.com

The analysis of spinal alignment for thoracolumbar dislocated fractures（type C）with posterior long-segment instrumentation

WANG Xiang, CAI Yi, ZHENG Ming-hui, QU Dong-bin

Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

Received:2016-09-01 Online:2017-01-25 Published:2017-02-22
Contact: QU Dong-bin, E-mail:nfyy_qu@163.com

摘要/Abstract

摘要：

目的　分析严重胸腰椎骨折脱位经后路长节段椎弓根螺钉内固定术后脊柱冠状位力线、矢状位力线恢复不良的情况及其原因。方法　分析33例胸腰椎骨折脱位（AO分型 C型）病例，均接受后路长节段内固定手术。在X线平片上测量患者手术前、后伤椎移位距离、脊柱侧（后）凸Cobb角；根据术后力线恢复情况，将患者分为力线恢复良好组（A组）和力线恢复不良组（B组），并分析螺钉数目、伤椎置钉等对术后脊柱力线恢复的影响。结果　33例患者中，力线恢复良好占60.6%（20 例），力线恢复不良占39.4%（13例）。两组患者固定节段和使用椎弓根螺钉总数方面的差异无统计学意义（P>0.05）；每个椎体椎弓根螺钉数目A组为（1.7±0.3）个，B组为（1.3±0.4）个，其差异有统计学意义（P＜0.05）。结论　严重胸腰椎骨折后路长节段内固定术后力线恢复不良并非少见，固定节段、螺钉使用数目、伤椎置钉等对术后脊柱力线的恢复有重要影响。

关键词: 胸腰椎骨折, 脱位, 力线, 长节段内固定, 螺钉数目

Abstract:

Objective　 The purpose of the retrospective study is to analyzethe imbalance of the spinal sagittal and coronalalignmentfor thoracolumbar fracture-dislocations with posterior long-segment pedicle screws instrumentation.　Methods　33 patients with thoracic or lumbar type C spinal injurieswere treated with long-segment fixation which contained four or more segments. The distance of the vertebrae moving forward or backward, Cobb angle and kyphotic angle were measured prior to and after surgery by radiography, and the spinal sagittal and coronal alignment was analyzed. 33 patients were divided into the group of balanced alignment (group A) and the group of imbalanced alignment (group B). Then we discussed influence of the number of pedicle screws placed on postoperative spinal alignment.　Results　Among all patients, there were 20 cases (60.6%) with balanced alignment, others (39.4%) with imbalanced alignment. The segments of instrumentation and the total number of pedicle screws showed no obvious difference between two groups (P>0.05). As far as the number of single vertebra screws was concerned, group A was 1.7±0.3 and group B was 1.3±0.4, which showed no significant difference (P＜0.05).　Conclusions　The imbalance of the spinal alignment often happened tothoracic or lumbar dislocated fractures with long-segment instrumentation. The segments of instrumentation, the number of screws, pedicular screw and so on play an important role in postoperative spinal alignment.

Key words: Thoracolumbar fracture, Dislocated, Alignment, Long-segment instrumentation, Number of pedicle screw

王翔,蔡毅,郑明辉,瞿东滨. 胸腰椎骨折脱位经后路长节段内固定术后力线不良及其原因分析[J]. 中国临床解剖学杂志, 2017, 35(1): 85-89.

WANG Xiang, CAI Yi, ZHENG Ming-hui, QU Dong-bin. The analysis of spinal alignment for thoracolumbar dislocated fractures（type C）with posterior long-segment instrumentation[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(1): 85-89.

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胸腰椎骨折脱位经后路长节段内固定术后力线不良及其原因分析

The analysis of spinal alignment for thoracolumbar dislocated fractures（type C）with posterior long-segment instrumentation

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