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胸椎/损伤

胸椎/损伤的相关文献在1990年到2020年内共计73篇,主要集中在外科学、中国医学、神经病学与精神病学 等领域,其中期刊论文73篇、专利文献24243篇;相关期刊20种,包括中国保健、中国针灸、医学临床研究等; 胸椎/损伤的相关文献由235位作者贡献,包括任朝晖、雷青、丁辉耀等。

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胸椎/损伤

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  • 任朝晖
  • 雷青
  • 丁辉耀
  • 万小敏
  • 严柳
  • 仁会
  • 仇裕丰
  • 付开珍
  • 付能高
  • 代平
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    • 王守刚; 岳海源
    • 摘要: [目的]探讨伤椎固定并重建后方韧带复合体治疗胸腰椎爆裂骨折的临床疗效.[方法]收集2012年6月至2018年6月在本院诊治的160例胸腰椎爆裂骨折的患者,采用伤椎固定并重建后方韧带复合体治疗,观察椎体复位程度及骨折愈合情况.[结果]术后随访8~61(38.40±6.36)个月.160例患者中,脊柱骨折按期愈合153例,占全部病例的95.63%;骨折延迟愈合6例,占全部病例的3.75%,总愈合率为99.38%.X线检查显示伤椎复张、无内固定物意外发生,脊髓功能ASIA分级提高1~3级.[结论]通过伤椎固定并重建后方韧带复合体治疗能有效避免脊柱失稳及内固定物意外,临床疗效确切,值得临床推广应用.
    • 唐锡国; 杨武; 唐锡辉; 王大朋; 李俊; 曹勇
    • 摘要: [目的]探讨两种不同前路减压植骨融合内固定术治疗胸腰椎爆裂性骨折的早期疗效分析.[方法]选择2017年1月至2018年12月在本院诊治的114例胸腰段爆裂性骨折患者,采用随机数表法分为对照组和观察组,每组57例.对照组给予常规前路减压内固定治疗,观察组给予前路选择性椎体切除减压及矩形椎体重建术.比较两组患者手术时间、术中出血量、术后引流量、植骨开始融合时间及术前、术后伤椎局部后凸角(Local kyphosis Angle,LKA)和椎体高度、神经功能恢复情况.[结果]观察组手术时间、术中出血量、术后引流量和植骨开始融合时间均少于对照组,其差异均有统计学意义(P<0.05).随访12个月,对照组患者56例完全融合率,观察组患者57例均完全融合,两组12个月时融合率无统计学差异(P>0.05).两组患者术后当天、术后12个月时VAS评分均较术前显著降低(P<0.05),但两组患者术前、术后当天、术后12个月时VAS比较差异均无统计学意义(P>0.05).两组患者术后当天、术后12个月LKA均低于术前,椎体高度高于术前,差异均有统计学意义(P<0.05);但两组患者术前、术后当天、术后12个月时LKA和椎体高度比较差异均无统计学意义(P>0.05);观察组术后LKA丢失和椎体高度丢失显著低于对照组,差异有统计学意义(P<0.05).两组术后12个月神经功能优于术前,差异均有统计学意义(P<0.05);两组患者术前、术后12个月神经功能分级比较差异均无统计学意义(P>0.05).[结论]选择性椎体切除和矩形椎体重建术治疗胸腰椎爆裂性骨折疗效显著,减少手术创伤,减少椎体沉降,值得临床推广应用.
    • 蔡永林; 王铭远; 祁国晓; 王俊鹏
    • 摘要: 目的 观察椎体后路切除减压联合骨移植治疗胸腰段爆裂性骨折的疗效.方法 选取2014年1月至2016年12月本院收治的胸腰段爆裂性骨折患者80例为研究对象,所有患者均接受腰椎切除减压联合骨移植,根据入路方式不同分为后路治疗组(40例)与前路治疗组(40例).记录两组手术情况,检测两组术前、术后3个月肺功能,观察两组术前、术后6个月日本骨科协会(JOA)评分、视觉模拟疼痛(VAS)评分、Cobb角、椎体前缘高度、美国脊髓损伤协会(ASIA)残损分级情况.结果 后路治疗组手术时间、术中出血量、术后住院时间均显著少于前路治疗组(P<0.05);术后3个月,两组肺活量(VC)、最大通气量(MVV)较术前显著增加(P<0.05),且后路治疗组显著优于前路治疗组(P<0.05);术后6个月,两组JOA评分较术前显著升高、VAS疼痛评分显著降低,且后路治疗组显著优于前路治疗组(P<0.05);两组术后6个月Cobb角、椎体前缘高度及ASIA残损分级情况比较,差异无统计学意义(P>0.05).结论 椎体前路与后路切除减压术联合骨移植均能有效修复胸腰段爆裂性骨折,但后路治疗对患者肺功能影响较小,术后腰椎功能恢复较好.
    • 张安旗; 康可
    • 摘要: 目的 对比单、双侧入路经皮球囊扩张椎体成形术(PKP)治疗胸腰椎椎体压缩性骨折(OVF)的早期疗效.方法 选取2013年6月至2016年6月在该院行PKP治疗的72例胸腰椎OVF患者作为研究对象,根据手术入路分为单侧组(单侧入路)与双侧组(双侧入路),各36例.以视觉模拟评分法(VAS)评估两组患者术前、术后3 d、术后3个月时的疼痛程度,比较两组患者手术用时、术中透视次数、骨水泥用量及渗漏率,术后3个月时比较两组Cobb角与椎体高度恢复情况.结果 两组患者各时间点VAS疼痛评分比较,差异均无统计学意义(P>0.05);两组患者术后3 d、3个月VAS疼痛评分均较术前明显下降,差异均有统计学意义(P0.05).结论 单侧与双侧入路行PKP均可有效缓解胸腰椎OVF患者的疼痛症状,修正脊柱的后凸角度,但单侧入路可有效缩短手术用时,减少骨水泥用量,值得在临床推广应用.
    • 郭克淼; 李晶
    • 摘要: [Objective]To investigate the significance of the degree of vertebral height loss and the degree of recovery of vertebral body height after operation and the clinical significance by measuring the size of the gap left by the bone defect in the thoracolumbar spine burst fracture before and after operation in CT images.[Methods]A retrospective review was made based on imaging material of forty patients who accepted posterior restoration and instrumentation through pedicle-screw implant technique because of thoracic or lumbar spine burst fracture.The preoperative and postoperative computed tomography (CT) scans were performed for each case,mid-sagittal or para mid sagittal scans were selected to measure the preoperative minimal residual vertebral body height (Pre-VBH),postoperative maximal vertebral body height restoration (Po VBH) and the maximal vertical gap-height (GH) within the restored vertebral body;the relationship between GH and PreVBH,Po-VBH was analyzed.At the same time,15 cases of internal fixation fracture caused by nonunion of vertebral fracture were analyzed retrospectively in order to explore the critical value of the percentage of vertebral compression,because of the too large gap in the vertebral body resulting in fracture nonunion.[Results] Preoperative minimal residual vertebral body height (Pre-VBH) ranged from 20.8% to 60%,averaged 48.2 %;postoperative maximal vertebral body height restoration (Po VBH) was 71.5 % ~ 127.3 %,averaged 93.3%;difference between Po-VBH and Pre-VBH was 21.4%~79.1%,averaged 45.7%;the maximal vertical gap-height (GH) within the restored vertebral body was 19.3 % ~76.7%,averaged 45.3 %.Statistical analysis demonstrated there was no significant difference between the value of Po-VBH minus Pre-VBH and the value of GH.The value of gap height in restored vertebral body measured and calculated in 15 failed cases of bone nonunion ranged from 44.5 % to 67.5%.[Conclusion] Accompanying the restoration of compressed vertebral body height,there is always vertical gap left within the fractured vertebral body,the height of vertical gap is nearly equal to postoperative maximal vertebral body height restoration (Po-VBH) minus preoperative minimal residual vertebral body height (Pre-VBH),which can facilitate us to formulate a formula:postoperative gap height (GH)≌(Po-VBH)-(Pre-VBH).If the value of the gap-height within restored vertebral body is 44.5% more than the height of vertebral body after fracture reduction,bone nonunion may be an inevitable result for thoracic or lumbar burst fracture.%[目的]通过测量胸、腰椎爆裂性骨折在手术前、后骨折椎体内因骨质缺遗留的空隙大小在CT影像上的变化,探讨伤椎椎体高度丢失的程度与手术后椎体高度恢复的程度对骨折椎体内空隙大小的影响及其临床意义.[方法]回顾性分析总结40例胸、腰椎爆裂性骨折患者手术前、后的影像资料.40例患者均采用后路开放复位椎弓根螺钉内固定术.在术前和术后均行胸腰椎CT扫描,选取正中矢状位或旁正中矢状位CT片用来测量出手术前骨折椎体残留的最小高度与下位邻椎高度的百分比(Pre-VBH)、手术复位后骨折椎体恢复的最大高度与下位邻椎高度的百分比(Po-VBH)以及骨折复位后椎体内垂直方向上空隙的高度与下位邻椎高度的百分比(GH).分析GH与Pre-VBH、Po-VBH的关系.同时对15例椎体骨折不愈合而导致的内固定断裂病例进行回顾性分析以探讨因为复位后椎体内空隙过大导致骨折不愈合的椎体压缩百分比的临界值.[结果]手术前骨折椎体残留的最小高度(Pre VBH)为20.8%~60%,平均为48.2%;手术后骨折椎体恢复的最大高度(Po-VBH)为71.5%~127.3%,平均为93.3%;Po-VBH与Pre-VBH的差值为21.4%~79.1%,平均为45.7%;手术后骨折椎体内实测的空隙高度(GH)为19.3%~76.7%,平均为45.3%.经统计学分析Po-VBH与Pre-VBH的差值数值与GH数值无显著性差异.15例骨折不愈合导致内固定失败病例测算出的骨折椎体复位后椎体内GH为44.5%~67.5%.[结论]伴随压缩性骨折椎体高度的恢复、骨折椎体内在垂直方向会出现骨缺损空隙,空隙高度的实测数值近似于“术后骨折椎体恢复的最大高度减去术前骨折椎体残留的最小高度”,可以用以下公式计算:GH≌“Po VBH”-“Pre-VBH”.如果复位后椎体内空隙的百分比大于骨折椎体复位后高度的44.5%,很可能会导致胸腰椎爆裂性骨折手术后不愈合.
    • 赵波; 邱晓文; 李萌; 王栋; 秦杰; 张峰
    • 摘要: [Objective]To investigate the clinical efficacy of the minimally invasive pedicle screw fixation for the treatment of unstable thoracolumbar fractures.[Methods]Thirty-seven patients of unstable thoracolumbar fracture without neurological symptoms from January 2011 to October 2012 were seen in the Departments of Orthopedics of the First and Second Hospitals of Xi'an Jiaotong University.There were 24 males and 13 females, aged 19 to 69 years (mean 31.8 ± 8.5 years).All cases were treated with minimally invasive percutaneous pedicle screw fixation techniques.The operation time, blood loss, vertebral height before and after surgery, Cobb's angle changes, and postoperative complications were collected and statistical analysis was conducted.[Results]The operation time was 1.1 (0.75 ~ 1.5) h, the bleeding volume was 20~100 (40.5±10) mL, and the follow-up time was 10~36 (19.8±5.6) months.There were significant differences in VAS scores four weeks and one year after operation compared to that on one day before operation (P0.05).Intraoperative complications accounted for three cases (8.1%), caused by improper pedicle screw placement resulting in piercing the outer wall, while there were no rupture of the dura mater and vascular injury patients.However, follow-up showed fracture healed without much deformity and height loss.The twelve-month follow-up had two patients with a total of three loose pedicle screws.There were two cases (5.4%) of ruptured pedicle screw;one case was seen six months after operation and another case was seen twelve months after operation.Only one case (2.7%) showed pedicle screw withdrawal twenty-four months after operation.[Conclusion]Minimally invasive percutaneous pedicle screw technology can minimize the damage on stability of the disease, not only to achieve the purpose of stabilizing the spine, but also to reduce intraoperative trauma.Under the premise of strict control of surgical indications, it can be widely used as a basic technology.%[目的] 探讨微创椎弓根螺钉固定复位术治疗不稳定性胸腰椎骨折的临床疗效.[方法] 收集2011年1月至2013年10月西安交通大学第二附属医院和西安交通大学第一附属医院骨科采用微创经皮椎弓根螺钉固定复位技术诊治的无神经症状的不稳定性胸腰椎骨折患者37例.记录手术时间,出血量,观察手术前后椎体高度、Cobb's 角变化,并统计术后并发症.[结果] 37例均获得随访.手术时间为1.1(0.75~1.5)h;出血量20~100 (40.5±10)mL;术后随访时间10~36(19.8±5.6)个月.术后4周、术后1年与术前1 d VAS评分比较差异有统计学意义(P0.05).术中并发症3例(8.1%),均系椎弓根螺钉置入不正确穿破外壁,无硬脊膜破裂及血管损伤患者.随访无明显后凸畸形和高度丢失,骨折全部获得愈合.12个月随访时发现2例患者共3枚螺帽松动;椎弓根螺钉断裂2例(5.4%),其中l例见于术后6个月,1例见于术后12个月;术后24个月椎弓根螺钉退出1例(2.7%).[结论] 微创经皮椎弓根螺钉技术可最大程度地减少对病椎稳定性的破坏,既能到达稳定脊柱的目的,又可减小术中创伤.在严格掌握手术适应证的前提下,其将会作为一项基础技术广泛应用.
    • 邓晓文; 黄强; 高秋明
    • 摘要: 目的 对比传统后路内固定术与微创经皮穿刺椎弓根固定术在胸腰椎骨折中的治疗效果.方法 回顾性分析2012年2月至2016年2月本院收治的161例胸腰椎骨折患者的临床资料,采用后路内固定术83例,微创经皮穿刺椎弓根固定术78例,比较两组之间手术时间、切口长度、术中出血量、术后引流量、住院时间、术前与术后的后凸Cobb角、椎体前缘高度、矢状面指数以及术前、术后1d、术后3个月的视觉模拟评分(VAS)和Roland-Morris功能障碍评分(RDQ).结果 两组治疗顺利完成.微创经皮穿刺椎弓根固定术组的手术时间、切口长度、术中出血量、术后引流量、住院时间与后路内固定术组相比较明显减少,差异具有统计学意义(P<0.05).两组术后后凸Cobb角、椎体前缘高度、矢状面指数与术前比较差异有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05).两组术后1d、术后3个月RDQ评分与术前比较差异具有统计学意义(P<0.05).两组患者术后3个月VAS评分与术前比较差异有统计学意义(P<0.05);而后路内固定组术后1d与术前差异无统计学意义(P>0.05),微创经皮穿刺椎弓根固定术组术后1d与术前相比差异有统计学意义(P<0.05).微创经皮穿刺椎弓根固定术组在术后1d的VAS、RDQ与后路内固定组相比差异有统计学意义(P<0.05).结论 后路内固定术与微创经皮穿刺椎弓根固定术治疗胸腰椎骨折效果相当,但微创经皮穿刺椎弓根固定术具有出血少、住院时间短、恢复快等优势.
    • 蒋仕林; 倪诚; 杜亮; 李国庆
    • 摘要: [Objective]To investigate the clinical effect of different segmental fixation of posterior pedicle screw in the treatment of severe thoracolumbar spine fracture.[Methods]The clinical data of 67 cases of severe thoracolumbar fractures from January 2012 to December 2014 in our hospital were retrospectively analyzed and divided into the observation group (n =36) and the control group (n =31) according to the different operation,the control group underwent posterior short segment pedicle screw fixation,and the observation group was treated with posterior long segment pedicle screw fixation.The operation condition,,nerve function,vertebral body anterior compression and Cobb angle were compared between the two groups.[Results]The operation time of the observation group was (158.7±33.9) min,significantly longer than (113.6±24.2) min (P <0.05);The amount of intraoperative bleeding was (386.4± 122.9) mL,significantly higher than that of the control group (+ 183.7 ±57.8) mL (P <0.05);3 months after operation,the spinal cord nerve function Frankel grade of the patients in both groups increased significantly (P <0.05),but there was no significant difference between the two groups (P >0.05);12 months after operation,the vertebral compression degree and Cobb angle of the patients in the two groups were significantly better than those before surgery (P <0.05);Cobb angle,Cobb angle correction rate,Cobb angle correction loss,vertebral leading edge correction loss of the observation group were significantly lower than those of the control group;but the vertebral anterior compression degree and vertebral anterior compression correction rate were significantly higher than those of the control group (P <0.05).[Conclusion] Long segment posterior pedicle screw internal fixation can effectively correct kyphosis of severe thoracolumbar spinal fracture and restore vertebral body height,and prevent the long-term correction loss,It is worthy of clinical application.%[目的]探讨后入路椎弓根钉不同节段固定治疗重度胸腰段脊柱骨折的临床效果.[方法]回顾性分析本院2012年1月至2014年12月收治的67例重度胸腰段脊柱骨折的临床资料,根据术式不同分为观察组(n =36)和对照组(n =31),对照组行短节段后入路椎弓根钉内固定治疗,观察组行长节段内固定治疗.比较两组患者的手术情况及神经功能、椎体前缘压缩度、Cobb角.[结果]观察组手术时间为(158.7±33.9)min,明显长于(113.6±24.2)min(P<0.05);术中出血量为(386.4±122.9)mL,明显多于对照组(183.7±57.8)mL(P<0.05);术后3个月,两组患者脊髓神经功能Frankel分级均明显提高(P<0.05),但两组间比较差异无统计学意义(P>0.05);术后12个月,两组患者椎体前缘压缩度、Cobb角均明显优于术前(P<0.05);观察组术后Cobb角、Cobb角矫正率、Cobb角矫正丢失度、椎体前缘矫正丢失度均明显低于对照组,椎体前缘压缩度、椎体前缘压缩矫正率均明显高于对照组(P<0.05).[结论]长节段后入路椎弓根钉内固定术可有效矫正重度胸腰段脊柱骨折患者后凸畸形,恢复椎体高度,并有效预防远期矫正丢失,值得临床推广应用.
    • 邹逢文; 吴小华; 张宪彧; 双鸥
    • 摘要: 目的:观察后路内固定融合术治疗脊柱胸腰段骨折的疗效。方法选取86例脊柱胸腰段骨折患者,分为2组,对照组43例实施前路手术内固定治疗,观察组43例实施后路内固定融合术治疗,比较不同手术方法实施效果。结果观察组患者治疗有效率(88.4%)高于对照组(76.7%),手术时间(160±42)min、住院时间(10±2)d短于对照组(220±55)min(、17±5)d,,术中出血量(740±170)mL少于对照组(1180±165)mL,差异有统计学意义(P<0.05)。结论后路内固定融合术用于矫治脊柱胸腰段骨折,创伤小,有利于患者身体健康早日恢复。
    • 李华平; 樊世峰; 陈爱国; 管英; 何大庆; 姚裴; 赵世杰
    • 摘要: 目的:探讨经后路伤椎植骨置钉钉棒系统内固定治疗胸腰椎骨折的临床疗效。方法系统回顾分析2013年1月至2015年1月该院收治的48例胸腰椎骨折患者采用经后路伤椎植骨置钉钉棒系统内固定治疗的临床资料,对比分析手术前后、末次随访时的影像资料,依据患者伤椎前缘、椎管横断面积、伤椎Cobb角的变化进行评价。所有患者均随访15~48个月,平均18.5个月。结果患者术后伤椎椎体高度、椎管横断面积得到恢复,Cobb角得到矫正,伤椎前缘压缩比、椎管横断面积、Cobb角术后1周较术前显著改善,差异有统计学意义(P0.05),无钉棒系统内固定失效。结论经后路伤椎植骨置钉钉棒系统内固定治疗胸腰椎骨折术后有效恢复伤椎椎体高度、椎管横断面积,防止伤椎节段脊柱后凸畸形的发生,明显降低了远期并发症,临床疗效显著。
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