经伤椎置钉技术治疗胸腰椎骨折的临床应用

Clinical applications with pedicle screws fixation at the fractured vertebra in the treatment of thoracolumbar fractures

目的探讨后路经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。方法自2010年3月～2012年4月后路经伤椎椎弓根螺钉内固定治疗胸腰椎骨折患者30例,其中男19例,女11例;年龄19～61岁,平均39.6岁。分别测量术前、术后1周及末次随访时椎体前缘高度、后凸Cobb's角,对测量数据进行统计学分析。ASIA评分:A级4例,B级9例,C级5例,D级7例,E级5例。结果 2例失访,其余患者均获得随访,平均随访时间11.7个月。所有患者均获得骨性愈合。较术前而言,术后1周、末次随访时椎体高度显著改善(1.42±0.33mmvs3.62±0.30mm、3.56±0.42mm,P<0.01),Cobb's角亦显著改善(33.5±7.6°vs6.5±2.0°、6.2±1.5°,P<0.01)。末次随访时ASIA评分为:A级4例,B级3例,C级4例,D级7例,E级10例,较术前明显改善。结论经伤椎椎弓根螺钉内固定能有效重建胸腰椎前、中、后三柱的稳定性,临床疗效满意。

Objective To explore the clinical effects of thoracolumbar fractures with pedicle screws fixation at fractured vertebra.Methods Thirty cases with thoracolumbar fracture were treated with pedicle screws fixation at the fractured vertebra from March 2010 to April 2012.Among them,there were 19 males and 11 females,and the mean age was 39.6 years old(from 19 to 61 years old).Preoperation,one week after operation and the last follow-up point,the cases were evaluated with X-ray for detecting anterior heights of the fractured vertebra and the Cobb's angle.The ASIA score were 4 cases with A grade,9 cases with grade B,5 cases with grade C,7 cases with grade D and 5 cases with grade E.Results Twenty cases were followed up with an average of 11.7 months.All cases got bone healing.Compared with the preoperative point,vertebral height improved significantly(1.42 ±0.33 mm vs3.62 ±0.30 mm,3.56 ±0.42 mm,P <0.01) and Cobb's angle also improved significantly(33.5±7.6° vs 6.5±2.0° and 6.2±1.5°,P<0.01) in one week after operation and the last follow-up point.ASIA score at last follow-up point were 4 cases with A grade,3 cases with grade B,4 cases with grade C,7 cases with grade D and 10 cases with grade E.Conclusions Pedicle screws fixation at the fractured vertebra may effectively rebuild the three-column stability of thoracolumbar spine and with the method.