【作者】 石鹏；

【导师】 陈鲁峰；

【作者基本信息】 福建中医药大学 ， 中医骨伤科学， 2010， 硕士

【摘要】 目的：评价后路椎弓根钉系统内固定并结合后外侧植入自体髂骨治疗胸腰段脊柱爆裂性骨折的临床疗效。方法：依据随机分配原则,将60例胸腰段脊柱爆裂性骨折病例随机分为两组(单纯应用后路椎弓根钉组、椎弓根钉结合后外侧植骨组)进行治疗。通过观察和测量术前、术后及随访时伤椎后凸畸形角(Cobb角)、患椎楔变角(anterior welded angel, AWA)、伤椎前缘高度百分比(Anterior Vertebral Height, AVH)、ODI评分的变化,结合术后融合率及中晚期并发症,对两组疗效进行评估。结果：(1)两组手术时间及术中出血量在统计学上有非常显著性差异(p<0.01),A组比B组手术时间短,术中出血少；(2)A组：AVH、Cobb角、AWA在手术前后、术前和随访时在统计学上均有非常显著性差异(P<0.01)；术后即刻和内固定物取出前时比较无统计学意义(P>0.05)。术后即刻与末次随访时、内固定取出前和末次随访时比较,有显著性差异(P<0.05)。A组融合2例,融合率为6.67%；ODI评分：术前和术后、末次随访时比较,在统计学上有非常显著性差异(P<0.01)；术后与末次随访时比较,统计学上有显著性差异(P<0.05)。(3)B组：AVH、Cobb角、AWA、ODI评分在手术前后、术前和随访时在统计学上均有非常显著性差异(P<0.01);术后和随访时比较,在统计学上无统计学意义(P>0.05)。B组融合30例,融合率为100%；(4)两组间比较,Cobb角、AWA、AVH术前、术后即刻、内固定取出前在统计学上均无统计学意义(P>0.05),末次随访时有显著性差异(P<0.05)。两组末次随访时ODI评分在统计学上有显著性差异(P<0.05)。结论：1、后路椎弓根螺钉内固定系统是一种治疗急性胸腰段脊柱爆裂骨折行之有效的方法；2、结合后外侧植骨融合可恢复骨折椎体处的力线传导,能够有效的降低后路手术后远期矫正度丢失及术后并发症的发生。更多还原

【Abstract】 Objective:To investigate the clinical effect of Thoracolumbar Burst Fractures by selective treatment of Pedicle Screw Internal Fixation combined with Posterlateral Fusion.Methods:Under the principle of random contrast,60 cases of Thoracolumbar Burst Fractures were randomly divided into two groups according to their treatents:group A were only treated with Pedicle Screw Internal Fixation while group B were treated with Pedicle Serew Internal Fixation combined with Posterlateral Fusion. Then the clinical effects of the two groups were observed, compared and assessed according to the changes of the cobb angle, the anterior welded angel(AWA), the anterior vertebral hight(AVH) and ODI at the preoperative, postoperative and follow-up stages, the postoperative fusion rate and the complications happened during and after the treatments.Results:(1)There is a distinctive difference between the two groups on poerttion time and the amount of bleeding:the poerttion time of A group is shorter and and the bleeding of A group is less than B group.(2)A group:there are very significant statistic differences of AVH, the cobb angle, and AWA (P <0.01) between the preoperative stage and the postoperative and follow-up stages. There is no statistic significance (P>0.05) between the postoperative stage and before taking-fixation. But all guide lines show statistic differences(P<0.05) between the final follow-up and the postoperative and before taking-fixation.There are two cases fusioned in A group. The fusion rate is 6.67%. The ODI rating shows significant differences between the preoperative, the postoperative and the final follow-up stage(P< 0.01).The differences between the postoperative and the final follow-up stage are significant.(3)B group:there are significant differences of AVH, the cobb angle, AWA and ODI(P<0.01). between the preoperative and the postoperative stages, before taking-fixation and the final follow-up. There is no statistic significance (P>0.05) between the postoperative stage and the follow-up stage. There are 30 cases fusioned in B group. The fusion rate is 100%.(4) The cobb angle, AVH and AWA show no statistic differences between the preoperative, the postoperative and before taking-fixation. But all guide lines have statistic difference at final follow-up stage (P<0.05). The ODI rating has statistic difference at the final follow-up (P< 0.05).Conclusion: 1. Pedicle Screw Inernal Fixation is effective on Thoracolumbar Burst Fractures.2. Pedicle Serew Interanl Fixation combined with Posterlateral Fusion on Thoracolumbar Burst Fractures can lower the probality of complications and the loss of Correction Degree after the operation.更多还原