胸腰椎骨折后路椎管减压AF内固定

Treatment of Thoracolumbar Fracture with AF Device Fixation and Vertebral Body Graft via Spinal Canal

目的：研究AF椎弓根螺钉固定的临床治疗方法和治疗效果。方法：对41例胸腰椎骨折行内固定，有椎体或椎板骨折导致椎管狭窄和脊髓压迫．应进行椎管减压，并常规行小关节及横突间植骨。术后常规引流48h，植骨者术后卧床4周．佩带支具1年。结果：41例中随访36例，随访时间3～36月，平均17．5月。根据手术前后影像学评价（椎体高度的恢复，椎管侵占率．脊核后凸cobbs′角）和神经功能评价（Francel分级），优良率80．5％．其中2例分别于手术后7个月和9个月出现固定系统的松动，经取出固定系统、卧床佩带支具后病情稳定，骨折愈合。结论：AF椎弓根螺钉固定牢固可靠．能达到精确复位固定及椎管有效减压．疗效确切。

Objective：To approach the operative method and clinic effect of AF device fixation and vertebral body graft via spinal canal for treatment of thoracolumbar fracture. Methods：Forty-one cases with thoracolumbar fracture were treated with AF device fixation and vertebral body bone graft via spinal canal and posterior bone graft. After operation,the patient should lie on bed for 4 weeks. The back was wrapped with the waist fixation for 1 year. Results： Thirty-six cases were followed up for 3 months to 3 years,which gained excellent and good results, （80.5%）through evaluations of fluoroscopy （recovery of the height of lumbar vertebras,the invasion of the tube and the Cobb angle of the spinal surface） and neuro pathological function（Frankel grade）of inter-operation and post-operation. There were no breaking of nails and shafts,and other complications. Conelusion：AF fixation can restore and fix the thoracolumbar spinal fracture, vertebral body graft via spinal canal and posterior bone graft can increase the stability of the spine.