AF椎弓根内固定系统治疗胸腰椎爆裂骨折

Characteristics of thoracolumbar burst fractures treated with AF instrumentation

目的 评价AF椎弓根螺钉内固定治疗胸腰椎爆裂骨折的疗法。方法 1998～ 2 0 0 2年采用AF钉治疗胸腰椎爆裂骨折 92例 ,并通过术后X线平片测量椎体高度及复位情况 ,定期随访。结果 (1)术前有不完全神经损伤者 6 2例 ,有 91.9% (5 7/6 2 )恢复Frankel分级 1级以上 ,完全神经损伤者无明显恢复 ;(2 )Cobb’s角由术前 2 4 .5°(12～ 4 5°)矫正到术后平均 2 .4°(0～ 7°) ,椎体前后缘高度由术前 4 3% (2 2 %～ 6 5 % )和6 5 % (31%～ 75 % )恢复到术后的 93% (90 %～ 10 0 % )与 97% (94 %～ 10 0 % ) ;(3)断钉及针道松动 2例 ,伤口渗液 1例。结论 AF椎弓根内固定系统治疗胸腰椎爆裂骨折有利于恢复神经功能 ,恢复椎体高度和生理弯曲 ,但也存在矫正角度丢失、断钉及针道松动等问题。

Objective To seek a simple and reliable operation method for the treatment of thoracolumbar burst fracture.Methods Ninty-two cases of thoracolumbar burst fracture were treated with AF instrumentation.All of them were checked with radiography for anterior and posterior heights of compressed vertebral bodies.Results (1)Neurological status improvement at least 1 Frankel grade was found in 91.9% (57/62),while no improvement was obeained in those who had preoperative complete paraplegia;(2)Cobb's angle was corrected from 24.5°(12°～45°) preoperatively to 2.4°(0°～7°) postoperatively,anterior and posterior heights of compressed vertebral bodies were restored from 43%(22%～65%) and 65%(31%～75%)preoperatively to 93%(90%～100%) and 97%(94%～100%) postoperatively respectively;(3)break of screws occurred in 2 cases,and seepage occurred through incision in 1 case.Conclusion AF instrumentation provides satisfactory stability for thoracolumbar burst fractures.It helps physiologic postural contour restoration and facilitates recovery of neural function,but is associated with troubles of implant failure correction,break of screwscad and loosen of screw.