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頁籤選單縮合
題名 | Surgical Outcomes of Short-Segment Fixation for Thoracolumbar Fracture Dislocation=短節鋼釘固定胸腰椎骨折併脫臼的手術結果 |
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作者 | 于尚文; 范國豐; 曾益全; 邱益立; 陳永仁; 陳文哲; | 書刊名 | 長庚醫學 |
卷期 | 25:4 2002.04[民91.04] |
頁次 | 頁253-259 |
分類號 | 416.61 |
關鍵詞 | 胸腰椎; 下腰椎; 骨折併脫臼; 短節固定; 併發症; Thoracolumbar spine; Low lumbar spine; Fracture-dislocation; Short-segment fixation; Complications; |
語文 | 英文(English) |
中文摘要 | 背景: 胸腰椎骨折併脫臼的病例,一般以長節鋼釘來固定。而短節鋼釘固定是否也可當作另一種治療方式的選擇?本篇主要探討短節固定胸腰椎骨折併脫臼的病例可能產生的利益或併發症。 方法: 共有20例胸腰椎骨折併脫臼的病例,加以追溯探討,分析其臨床上、神經學上、放射線上及併發症上的評估,平均追蹤三年。 結果: 在追蹤的過程中,只要發現脊椎前屈的角度增加10度以上,移位的程度增加10個百分比以上,鋼釘或鋼架的損壞,假關節的形成,都以併發症的方式來加以分析。結果發現短節固定胸腰椎骨折併脫臼的病例中,在下腰部(腰椎第3、4、5節)有很高的併發症。 結論: 在治療胸腰椎骨折併脫臼的病例時,往往需要更牢靠的固定,而且短節固定往往會造成很高的失敗率。在有些受損很嚴重的病例,往往需要前後骨融合術的方式來治療。而且術後最初的脊椎體位的好壞,對最後的癒後也有很重要的影響力。 |
英文摘要 | Background: Currently long-segment pedicle instrumentation for a thoracolumbar (T-L) fracture-dislocation is gaining in popularity. Otherwise, short-segment fixation may be chosen as an another treatment method. This article evaluates the efficacy and complication of short-segment fixation for the treatment of thoracic or lumbar spine fracture-dislocation. Methods: Twenty patients with thoracic or lumbar spine fracture-dislocation were included in the study. The mean follow-up period was 3 year. Clinical, neurologic, radiologic (angle of deformity, displacement percentage, fusion rate), and complication outcomes were analyzed retrospectively. Results: The rate of failure, defined as an increase of 10。 or more in local kyphosis, an increase of 10% or more in displacement percentage, the development of pseudarthrosis, and/or implant failure, was analyzed. Short-segment instrumentation had a higher failure rate in the lower lumbar region (L3-L5) and a lower rate at the thoracolumbar junction (T11-L2). Conclusion: Thoraclumbar fracture-dislocation required firmer fixation especially in the low lumbar region, and short-segment fixation resulted in a high failure rate. Circumferential anterior and posterior fusion often played a role in certain severely injured cases. Good postoperative spinal alignment is crucial to a good outcome. |
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