Zheng Yuan-hua, Zhang Wei, Li Yuan, Wang Mei-Ying
Department of Orthopaedics, Central Hospital of Shangqiu, Shangqiu 476000, Henan, China.
Zhongguo Gu Shang. 2010 Apr;23(4):268-70.
To explore the effect of self-made L-shaped reductors combined with pedicle screw internal fixation for the treatment of thoracolumbar bursting fractures.
From Mar. 2003 to Oct. 2006, a total of 34 patients with thoracolumbar bursting fractures were treated. Among the patients, 26 patients were male and 8 patients were female, with an average age of 42 years (ranged from 18 to 67 years). The course of injury ranged from 6 hours to 7 days. The site of fractures: 3 patients in T11, 9 patients in T12, 15 patients in L1, 7 patients in L2. Preoperative CT showed that posterior wall of the fractured vertebral body were incomplete, bone broke into the spinal canal and compressed epithet dural sac. All the patients had symptoms of varying degrees of nerve injury. The posterior median approach was adopted, and self-made L-shaped reductors were used to press and restore the fractured bones that intruding to vertebral canal through the anterior of vertebral canal, then posterolateral fusion was made. Based on postoperative X-ray and CT inspection the effects were observed by injured vertebral height, cobbs angle, spinal canal stenosis, and symptoms of recovery.
All the patients were followed-up with an average of 2 years. The mean anterior and posterior vertebral height increased to normal as (95.23 +/- 1.90)% and (98.37 +/- 1.45)% respectively, which were higher than those of per-operation. The post-operative average Cobb angle was (4.93 +/- 1.41) degrees, which was smaller than that of pre-operation. Postoperative CT showed that the average ratio of protruded bones to the spinal canal anteroposterior diameter was (6.77 +/- 1.57)%, which was smaller than that of pre-operation. All of neurological functions were improved over one grade.
L-shaped reductors combined with pedicle screw internal fixation for the treatment of thoracolumbar bursting fractures has many advantages of simple works, good reduction, fixed securely and better results, and so on.
探讨自制L形复位器联合椎弓根螺钉内固定治疗胸腰椎爆裂骨折的疗效。
2003年3月至2006年10月，共治疗34例胸腰椎爆裂骨折患者。其中男性26例，女性8例，平均年龄42岁（18～67岁）。受伤时间为6小时至7天。骨折部位：T11 3例，T12 9例，L1 15例，L2 7例。术前CT显示骨折椎体后壁不完整，骨块突入椎管压迫硬脊膜囊。所有患者均有不同程度的神经损伤症状。采用后正中入路，使用自制L形复位器经椎管前方按压复位突入椎管的骨折块，然后行后外侧融合。根据术后X线和CT检查，通过伤椎高度、Cobb角、椎管狭窄及恢复情况观察疗效。
所有患者均获随访，平均随访2年。伤椎前缘和后缘高度平均恢复至正常的（95.23±1.90）%和（98.37±1.45）%，均高于术前。术后平均Cobb角为（4.93±1.41）°，小于术前。术后CT显示突入椎管骨块占椎管前后径的平均比例为（6.77±1.57）%，小于术前。所有患者神经功能均改善1级以上。
L形复位器联合椎弓根螺钉内固定治疗胸腰椎爆裂骨折具有操作简单、复位良好、固定可靠、效果较好等优点。
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