SF钉治疗胸腰椎骨折疗效探讨(附25例分析)

Treatment of thracolumbar fractures with SF instrumentation.

目的 探讨腰椎滑脱症和胸腰骨折的内固定器 (简称SF钉 )椎弓根钉治疗胸腰椎骨折的疗效。方法 后路SF钉治疗 2 5例胸腰椎单节段骨折患者 ,按Denis分型 :压缩型骨折 6例 ,爆裂型骨折 16例 ,安全带型骨折 1例 ,骨折脱位型 2例。 10例行后路椎板减压植骨融合。术后随访 3个月至 2年 3个月 ,平均 1 5年。全部病例于术前、术后及末次随访时摄伤椎X线片 ,记录伤椎前后缘高度cobb氏角 ,椎管横截面积 (% ) ,全部病例按Frankle分级行术前、术后神经功能评定。结果 ①手术前后相比伤椎前、后缘高度平均纠正 3 6 8%和 14 5 % ,cobb氏角平均矫正 12 7°。随访时椎体畸形变扁 4例 (15 % )。其中以爆裂性骨折的椎体中央部丢失居多。②术前神经不全损伤者 ,术后 76%恢复 (12 /16) ,神经功能Frankel分级改善 1级或以上 ;但 5例完全性损伤者无恢复。③术后断钉 1例。结论 后路SF钉技术在胸腰椎骨折治疗中具有良好的复位伤椎、稳定脊柱、恢复神经功能的作用 ,植骨处理可提高手术的效果。而且此术式创伤小 ,并发症少 。

Objective To evaluate the long-term treatment effect of thoracolumbar fractures with the SF instrumentation. Methods Twenty-five patients with single thoracolumbar fractures were involved in this study,according to Denis classification including 6 cases of compressive fracture,16 cases of brust fracture,one case of seat belt fracture.and two cases of dislocated fracture. They were treated by using SF pedicle instrumentation.Among them posterior decompression and bone grafting. The period of follow up for all patients was ranged from there months to 27 months,being 18 months on the average. They had been checked by the radiography at the time before and after the operation. Before the implant removal and at their latest follow up visit.The Frankle classification was used to evaluate the function of spinal cord. Results ①On the average before and after operation the rate of correction of anterior-posterior vertebral body height and cobb angle were 36.8%,14.5% and 12.7° respectively.It found that deforming of vertebral body existed in 4 patients(15%)with burst fracture. ②Neurological function recovered one to two grades in 12 of the 16patients whose nerves had not been completely injuried before operation; however, there was no improvement in five of the 21 patients, whose nerves were completely injuried before operation. ③ Among the 25 patients ; the broken of pedicle screws was found in one patient. Conclusion The use of SF pedicle instrumentation can offer a simple,safe and effective way for the treatment of thoracolumbar vertebrae fracture.