椎弓根螺钉内固定治疗中上胸椎骨折的临床研究

Treatment of Upper and Middle Thoracic Vertebrae Fractures with Vertebral Pedicle Screws

目的 探讨应用椎弓根螺钉内固定治疗不稳定中上胸椎骨折的安全性和可行性。方法 2001年3月～2005年1月，采用椎弓根螺钉内固定治疗不稳定中上胸椎骨折21例，其中GSS固定15例，USS固定6例。结果 21例均获随访，随访时间10～42个月，平均22，3个月，伤椎前缘高度由术前平均40％恢复至术后91％，术后CT示螺钉位置不良9枚，其中Ⅰ级6枚，Ⅱ级2枚，Ⅲ级1枚，术后无神经系统症状加重，无脑脊液漏。结论 胸椎椎弓根螺钉固定治疗不稳定中上胸椎骨折可获得满意的复位，中上胸椎椎弓根螺钉固定有一定风险，根据术前脊柱正侧位X线片和CT片，正确选择螺钉直径及进针点、角度和深度及进钉方向，胸椎椎弓根螺钉在中上胸椎骨折中的应用是安全的。

Objective To investigate the clinical safety and practicability of pedicle screws fixation in unstable upper and mtddte thoractc vertebrae fractures. Methods From March 2001 to January 2005, 21 patients with unstable upper and middle thoracic vertebrae fractures were treated with vertebral pedicle screw system fixation （GSS in 15 patients and USS in 6 patients）. Results All patients were followed up from 10 to 42 months, 22.3 months on average. During the following- up, 40% of the normal height of anterior vertebral body preoperatively was restored to 91% postoperatively. Nine screws were shown in malposition, wherein 6 in gradeⅠ, 2 in grade Ⅱand 1 in gradeⅢ. Neither deterioration of neurological deficit nor leakage of cerebrospinal fluid patient occurred postoperatively. Conclusion The vertebral pedicle screw fixation is effective in treatment of upper and middle thoracic vertebrae unstable fractures. There are potential risks in implanting pedicle screws into the upper and middle thoracic vertebrae. Correct implantation depends on a comprehensive familiarity of pedicle anatomy, proper pedicle diameter and entry point and orientation.