AF椎弓根内固定治疗胸腰段骨折38例疗效观察

AF system for treatment of 38 cases with unstable thoracolumbar fractures and paraplegia

目的观察AF椎弓根螺钉内固定治疗不稳定性胸腰椎骨折合并截瘫的疗效.方法自1999年3月～2003年10月采用AF椎弓根螺钉内固定结合复位法治疗不稳定性胸腰椎骨折并截瘫38例.结果 Cobb's角由术前23.8°矫正到术后平均2.6°.椎体前、后高度由术前46%和70%恢复到术后的92%到97%,三者均有显著统计学差异P＜0.01.术后平均随访10.5个月,32例不完全性截瘫患者均有1～3级恢复,6例全瘫患者中,4例有1、2级恢复.结论 AF椎弓根内固定系统可使突入椎管腔内的伤椎椎体后壁复位满意,固定牢靠,并能达到间接的椎管减压.但在某些前、后纵韧带完整性已遭破坏的爆裂型骨折、脱位病例,推移复位法可作为AF内固定系统的必要补充.

Objective: To evaluate the clinical results of patients with unstable throacolumbar fractures and paraplegia treating by AF(atlas fixation) system. Methods: A total of 38 cases with unstable thoracolumbar fractures and paraplegia were treated by AF operation between March 1999 to and 2003. Results: Cobb′s angle was corrected from 23.8° preoperatively to 2.6° postoperatively. Anterior and posterior height of vertebral bodies was restored from 46% and 70% preoperatively to 92% and 97% postoperatively. The three differences were statistically significant (P﹤0.01). Followed up for an average of 10.5 months, six patients progressed 1～3 grade in 32 patients with incomplete paraplegia, and 4 patients progressed 1, 2 grade in 6 patients with complete paraplegia. Conclusions: AF system can achieve satisfactory reduction, stable fixation and indirect decompression of spinal canal in cases with retropulsed fragment of posterior margin of the vertebral body in the canal. But in the cases with burst fractures and disrupted anterior and/or posterior longitudinal ligaments, push reduction was complementary to AF internal fixation system.