改良法经病椎植钉复位椎弓根植骨后路钉棒治疗胸腰椎爆裂性骨折

IMPROVED METHOD OF TREATING THORACOLUMBAR BURST FRACTURE BY POSTERIOR PEDICLE FIXATION AND GRAFTING THROUGH INJURED VERTEBRAE

目的探讨改良法经病椎椎弓根植钉、复位、植骨及后路钉棒系统治疗胸腰椎爆裂性骨折的方法和临床疗效。方法 2008年3月-2010年9月,对21例胸腰椎爆裂性骨折患者行经病椎椎弓根植钉、复位、植骨及后路钉棒系统内固定术。其中男15例,女6例;年龄20～61岁,平均38.4岁。累及节段:T125例,L17例,L25例,T12～L14例。Frankel神经功能分级:A级2例,B级4例,C级6例,D级5例,E级4例。按Denis分型均为爆裂性骨折,其中A型7例,B型11例,C型3例。术前、术后及随访时行X线片检查测量伤椎椎体高度、后凸Cobb角,评价神经功能改善情况。结果患者术后切口均Ⅰ期愈合。21例均获随访,随访时间12～30个月,平均26个月。无内固定物松动及断裂发生。X线片示骨折均达骨性愈合,愈合时间12～23个月,平均16个月。术后1周及1年时后凸Cobb角分别为(3.4±2.4)°和(5.2±3.2)°,两时间点间变化不明显,差异无统计学意义(P>0.05),但均较术前(22.1±1.2)°显著降低,差异有统计学意义(P<0.05)。术后1周伤椎前缘高度恢复至(36.0±2.0)mm,伤椎前缘高度与正常相邻上下位椎体高度比值为95.3%±1.3%,术后1年分别为(35.0±2.4)mm和94.4%±2.5%,两时间点间高度丢失不明显(P>0.05),但均较术前(14.6±2.1)mm和40.2%±1.5%显著提高(P<0.05)。术后1年患者Frankel神经功能分级较术前有不同程度恢复,与术前比较差异有统计学意义(χ2=11.140,P=0.025)。结论改良法经病椎椎弓根植钉、复位、植骨以及后路钉棒系统治疗胸腰椎爆裂性骨折可重建脊柱前中柱稳定性,防止后期矫正角度及椎体高度的再丢失。

Objective To discuss the improved method and effectiveness of posterior pedicle-screw fLxation combined with restoring and grafting through the injured vertebrae for treating thoracolumbar burst fracture. Methods Between March 2008 and September 2010, 21 patients with thoracolumbar burst fracture were treated by posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae. Of 21 cases, 15 were male and 6 were female with an age range of 20-61 years （mean, 38.4 years）. Affected segments included T12 in 5 cases, L1 in 7 cases, L2 in 5 cases, and T12-L1 in 4 cases. According to Frankel classification tbr neurological function, 2 cases were rated as grade A, 4 cases as grade B, 6 cases as grade C, 5 cases as grade D, and 4 cases as grade E; based on Denis classification, all 21 cases were burst fractures, including 7respectively, showing significant differences when compared with preoperative angle （22.1 ± 1.2）° （P 〈 0.05）, while no significant difference between 1 week and 1 year after operation （P 〉 0.05）. The anterior height of injured vertebrae recovered from （14.6± 2.1） mm （40.2% ± 1.5% of the normal） at preoperation to （36.0 ± 2.0） mm （95.3% ± 1.3% of the normal） at 1 week, and to （35.0 ± 2.4） mm （94.4% ± 2.5% of the normal） at 1 year; significant differences were found between preoperation and postoperation （P 〈 0.05）, while no significant difference between 1 week and 1 year after operation （P 〉 0.05）. At 1 year after operation, the Frankel neurological function grade was improved in varying degrees, showing significant difference when compared with preoperative grade （X^2=11.140, P=0.025）. Conclusion Improved method of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae in treatment of thoracolumbar burst fracture can reconstructthe anterior and middle column stability and prevent loss of Cobb＇s angle and height of vertebrae.