自制C形椎管内骨折复位器在胸腰段爆裂骨折后路手术中的应用

The application of self-made C-shaped spinal fracture reductor in posterior surgery for thoracolumbar burst fracture

中文关键词:  胸腰椎爆裂骨折  复位  C形椎管内骨折复位器  直角形复位器

英文关键词:Thoracolumbar burst fracture  Reduction  C-shaped spinal fracture reductor  Square redactor

中文摘要:

  【摘要】　目的：评价自制C形椎管内骨折复位器在胸腰段爆裂骨折后路手术中对椎管内骨折块的复位效果。方法：将78例符合纳入标准（单节段胸腰段爆裂骨折，骨折块突入椎管，椎管狭窄，合并脊髓神经损伤等）的胸腰段爆裂骨折住院患者随机分入观察组和对照组，两组患者均行后路椎板减压椎管成形、钉棒系统内固定术。观察组在术中应用自制C形椎管内骨折复位器复位椎管内骨折块，对照组应用传统的直角形复位器复位椎管内骨折块。随访并评价两组患者术后局部矢状面Cobb角、伤椎椎体前后缘高度、伤椎椎管截面积以及脊髓神经功能的恢复情况。结果：观察组获得随访34例，对照组获得随访33例，随访时间均为6～12个月，观察组平均7.9个月；对照组平均7.8个月。末次随访时观察组与对照组的局部矢状面Cobb角分别平均恢复15.32°±5.81°和17.58°±7.33°；伤椎椎体前缘高度恢复率分别为（67.32±11.74）%和（66.67±10.78）%；伤椎椎体后缘高度恢复率分别为（54.68±20.13）%和（45.53±32.99）%；脊髓神经功能ASIA评分分别恢复34.53±19.81分和26.97±12.57分；Frankel分级恢复中位数分别为1.0（1.0，2.0）和1.0（1.0，1.0），两组之间的恢复率或恢复分值比较均无统计学差异（P＞0.05）。观察组与对照组术后椎管截面积恢复率分别为（85.97±8.74）%和（76.30±6.64）%，组间比较有统计学差异（P＜0.05）。结论：在胸腰段爆裂骨折后路手术中采用自制C形椎管内骨折复位器，对突入椎管内的骨折块进行复位，可较好地恢复椎管容积，优于传统的直角形复位器。

英文摘要:

  【Abstract】 Objectives: To evaluate the application of self-made C-shaped spinal fracture reductor in posterior surgery for thoracolumbar burst fracture. Methods: 78 hospitalized patients with thoracolumbar burst fractures and meeting criteria(single level involved, spinal canal encroachment and stenosis, neurological deficit) were recruited and divided into test group and control group.　All patients underwent posterior laminectomy and anterior decompression, fixation screw and rod system. A self-made C-shaped spinal fracture reductor was applied to reduce the fracture fragments in test group, while in control group, traditional square reductor was applied. Cobb angle, the height of anterior and posterior of the injured vertebrae, the section area of the injured spinal canal and spinal neurological function were reviewed and compared in two groups. Results: 34 cases in test group and 33 cases in control group were followed up, with an average follow-up of 7.9 months and 7.8 months for test group and control group respectively. The improvement of spinal kyphosis, the recovery rate of the vertebra height, ASIA score, Frankel grade of median recovery between test and control group was 15.32°±5.81° and 17.58°±7.33°,　(67.32±11.74)% and (66.67±10.78)%,　(54.68±20.13)% and (45.53±32.99)%, 34.53±19.81 and 26.97±12.57, 1.0(1.0, 2.0) and 1.0(1.0, 1.0) respectively, which showed no statistical significance(P＞0.05). The improvement rate of spinal canal cross-sectional area was (85.97±8.74)% and (76.30±6.64)% respectively(P＜0.05). Conclusions: Self-made C-shaped spinal fracture reductor can be used to reduce the fracture fragment, which can recover the volume of spine canal and is superior than the conventional square reductor.