导针定位在胸腰椎骨折前路手术中置钉的应用研究

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Abstract Objective To comparative study the clinic application of guide pin during operation via anterior approach for thoracolumbar fractures.Methods We prospective controlled analyzed the direction of nail in 60 patients consecutively treated with surgery via anterior approach in thoracic and lumbar fractures between May 2014 and Oct 2016.There were 53 cases who finished the follow-up in the end.These 53 cases included 33 males and 20 females at the age of 27~61 years(mean 39.4±12.8 years).The causes of injury were falling in 37 patients，traffic accidents in 6 patients，impact from heavy material in 10 patients.The fracture site was T₁₂ in 5 patient，L₁ in 37 patients，L₂ in 6 patients，L₃ in 4 patients，and L₄ in 1 patients.According to AO classification，50 cases were type A，3 case were type B.According to The Frankel assessment of neurological，status grade was A in 6 cases，B in 4 cases，C in 10 cases，D in 21 cases，and E in 12 cases.Anterior fixation was performed with the Antares and the Anterior(Medtronic，Sofamor Danek) in all patients.The patients were divided into 2 groups randomly：orientation group(25 cases) and non-orientation group(28 cases).In orientation group，kirschner wire were used for X-ray to ascertain the direction of the vertebral screw；In non-orientation group，the shape of the vertebral the superior or inferior endplate.Radiograph images were evaluated for coronal Cobb angle and inserting angle between the screws and endplates.Amount of bleeding，the amount of blood collected by the body，operative time，and conditions of neurological functional recovery also be recorded.Results All patients’ incision level were 2 segments above the injured vertebrae.The mean post-operation coronal Cobb angle of orientation group was(1.89±3.18)° and the non-orientation group (3.26±3.09)°.There were statistical difference between two groups.Amount of bleeding was(230.4±209.8)mL，the amount of blood collected by the body was(170.0±132.0)mL，and operative time was(158.2±57.4) minutes in the orientation group.In the non-orientation group，it is(300.5±252.5)mL，(230.0±130.5)mL，and(180.1±65.4)minutes respectively.There were statistical difference between the twogroups in the three elements.Conclusion Orientation during operation can efficiently prevent the postoperative spinal lateral angulation in surgery via anterior approach for thoracolumbar fractures.

Key words： thoracolumbar spine fractures lateral angulation complications prevention

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