后路经椎弓根内固定治疗胸腰椎骨折

Posterior transpedicle fixation for thoracolumbar fractures

目的 总结后路经椎弓根固定治疗胸腰椎骨折的治疗经验 ,评估其临床疗效。方法 采用后路经椎弓根固定治疗胸腰椎骨折 6 8例 ,按McAfee分类 ,楔形压缩骨折 16例 ,稳定爆裂骨折 2 4例 ,不稳定爆裂骨折2 0例 ,Chance骨折 1例 ,屈曲牵拉型损伤 3例 ,平移型损伤 2例 ,T7平移型损伤合并T12 压缩骨折 1例 ,T10 屈曲牵拉型损伤合并L4压缩骨折 1例。术前术后X线片、CT片测量椎体高度恢复率、椎管横切面积、TSA角及SSA角 ,按Frankel评分评价手术效果。结果 平均手术时间约 97min ,平均术中出血量约 4 5 0ml。随访时间 2～ 2 2个月 ,平均 12个月。Frankel评分A级 18例中 2例术后上升 1级 ,其余无恢复 ,B～D级 2 2例均有 1～ 2级上升。螺钉植入椎弓根位置的优良率为 83 77% ,椎体压缩高度恢复优良率为 92 86 % ;椎体后凸角 (Cobb法 )及椎管横切面积复原满意。 6枚椎弓根螺钉折断 ,2 1枚弯曲 ,1例连杆折断 ,6例后期发现Cobb角有平均 5°再损失。结论 应用后路经椎弓根固定治疗胸腰椎骨折可以获得满意的治疗效果。

Objective To sum up the treatment experience and evaluate the effect of posterior transpedicle fixation for thoracolumbar fracture.Methods 68 cases of thoracolumbar fractures treated with transpedicle fixation were analyzed. According to McAfee classification, there were 16 cases of wedge compression fractures, 24 stable burst fractures, 20 unstable burst fractures, 1 Chance fracture, 3 flexion-distraction injuries, 2 translational injuries, 1 T 7 translational injury with T 12 compression fracture, and 1 T 10 flexion-distraction injury and L 4 compression fracture. The vertebral body high, spinal canal diameter in sagittal and transverse planes, TSA, SSA were measured by roentgenograph or CT pre-and post-operatively. The effect was evaluated with Frankel grades. Results The operation time was 97 min and the blood loss was 450 ml on average. All cases were followed up for 2～22 months, 12 on average. The Frankel grade was improved 1 grade in 2 of 18 cases of Frankel A, 1～2 grades in 22 cases of Frankel B～D. The excellent and good rate of pedicle screws placement was 83.77%; and that of vertebral high recovery was 92.86%; The kyphosis angle(Cobb’s) and spinal canal transverse area recovered satisfactorily; 6 screws broke and 21 bended. 1 connective rod broke. The Cobb’s angle lost 5°in 6 cases. Conclusion Satisfactory outcome can be obtained in the treatment of thoracolumbar fractures with posterior transpedicle screws fixation.