AF治疗胸腰椎骨折218例临床分析

Treatment of 218 cases of thoracolumbar fracture with AF pedicle screws

目的探讨AF治疗胸、腰椎骨折的应用方法和临床疗效。方法通过详细的影像学分析、AF角度螺栓生理性选择、交替进行的角度矫形和纵向牵引、不同情况下选择减压和复位的顺序等方法,共治疗胸、腰椎骨折患者218例,平均随访10个月,观察手术前后神经功能、椎体高度、椎管狭窄程度、矢状指数的恢复,以及并发症发生的情况。结果神经功能改善有效率84%；椎体前后缘高度恢复正常95%；椎管狭窄经术后CT检查94例术前椎管狭窄程度为“2”和“3”者,术后椎管狭窄程度为“0”占35%,“1”占65%；矢状指数由术前5°～36°,平均20．6°恢复到术后-5°～7°,平均0°；发生螺钉植入长度、角度错误,以及断钉、断棒等并发症占2．7%,无神经、血管并发症。结论正确地选择、应用AF治疗胸、腰椎骨折具有较高的安全性和临床实用性,并能最大程度上克服其设计上的不足。

Objective To evaluate the Clinical effects of the AF device used in the treatment of thoracolumbar fractures. Methods 218 cases of thoracolumbar fractures were treated with the AF device through carefully analysis of the images preoperatively, individually AF angled bolt selection, alternately kyphosis correction and traction in axis, different sequence of decompression and reduction. The mean follow-up time was ten months. Neurological function, vertebral body height, stenosis degree of the vertebral canal, sagittal index （SI） , and the complications were recorded. Results The effective rate of the neurological function recovery was 84%. The vertebral body height recovered to 95% compared to normal. 94 cases received CT scan after the surgery. In stenosis degree, grade 0 was 35%, and grade 1 was 65% postoperatively. SI improved from 20.6° to 0° in average. The hardware failure was 2.7% , and no neurovaacular complications. Condusion The right selection and manipulation of the AF device in the treatment of thoracolumbar fractures was safe and effective.