中西医结合疗法治疗胸腰椎不稳定性骨折

【作者】 韦竑宇；

【导师】 谭明生；

【作者基本信息】 北京中医药大学 ， 中西医结合临床骨科， 2003， 硕士

【摘要】 导师谭明生教授依据多年的骨伤科临床经验，以中西医结合理论为指导思想，结合中西医各自优点，摈弃其缺点，宏观与微观相结合，循古训“制器以正之，而辅手法之所不逮”，中西医疗法并重创新性研制出脊柱自动撑开复位器械（Spinal Auto-Reduction Fixer简称SARF），并制定出一套治疗胸腰椎不稳定性骨折的中西医结合疗法应用于临床。为论证脊柱自动撑开复位器械的刚性及最大撑开力，观察中西医结合疗法治疗胸腰椎骨折的临床疗效，探讨其作用机理，本文第一部分对脊柱自动撑开复位器械进行生物力学测试，测试该器械的刚度及最大撑开力。结果表明：1. SARF器械在Steffee器械的基础上增加了自动撑开功能，而且材质采用医用钛合金，经椎弓根螺钉采用锥形螺纹设计，螺纹从钉尖向上逐渐变浅，增粗了螺钉颈部的直径，提高了内植物的刚度和强度。其刚性强于其它经椎弓根器械。2. 在椎体能承受椎弓根钉的剪切力前提下，SARF器械的轴向撑开力完全足以使爆裂骨折的椎体复位。本文第二部分对25例胸腰椎不稳定性骨折进行临床观察，并以单纯SARF器械手术内固定组作对照。结果表明：1.中西医结合疗法对胸腰椎不稳定性骨折有很好的治疗作用，总有效率为100％，治疗后椎体前缘、后缘高度及临床症状变化较治疗前有明显改善（P<0.01）。2.练功活动能减少脊柱后凸畸形矫正角度丢失，明显优于对照组（P<0.01）。3.中成药回生第一丹能在一定程度上减轻腰背疼痛、促进骨折愈合。作者认为中西医结合综合疗法治疗胸腰椎不稳定性骨折适于运用于临床，并有必要进行深入研究。更多还原

【Abstract】 My tutor, Professor Tang Ming-sheng, a famous orthopedist，based on the theory of combination of TCM and western medicine and combined the both virtue of them. He abided traditional saying “using as proper device to make up for the defect of maneuver as possible”and invented the Spinal Auto-Reduction Fixer for Surgical treatment of unstable thoracolumbar fracture. At the same time he designed a series of therapeutic tool and applied them clinically.To test the max-force of distraction and the intensity of the fixer and evaluate the clinical effect of the combined therapy，we made a biomechanical experiment in the first stage. The experimental study showed that the biomechanical behavior of the Spinal Auto-Reduction Fixer is better than the other pedicle screw systems for the titanium alloy material and the coniod screws can make the fixer more rigid. In the second stage 25 cases with unstable fracture of thoracolumbar were treated with the new combined therapy. The results showed that: 1.with an average of 12 months follow-up, remarkable differences were seen in the index of Cobb’s angle, both prevertebral and postvertebral height of the vertebra, the clinical symptoms and reduction rate before and after treatment (P<0.01). The total effective rate was 100%. 2. Scientific training after operation is the key to reduce the incidence of kyphosis complications. The remarkable differences were seen in loss Cobb’s angle that had been corrected between this study and simple surgical treatment team. (P<0.01). 3.“Huisheng Diyi Dan”can reduce low back pain and speed up healing of bone fracture. The authors concluded that: the Spinal Auto-Reduction Fixer and the therapy of integrating traditional Chinese and western medicine are reasonable and effective. It brings about less trauma and satisfactory reduction and fixation effects and is worthy of going deep into study.更多还原