椎弓根钉内固定治疗老年性多节段胸椎骨折

Treatment of elderly multiple levels osteoporotic thoracic vertebrae fractures with vertebral pedicle screw

目的探讨应用椎弓根钉内固定治疗老年多节段胸椎骨折的疗效。方法对16例老年性多节段胸椎骨折患者行长节段后路椎弓根钉内固定，其中2节段6例，3节段6例，4节段4例。结果患者术后均未出现脊髓神经、血管、胸膜或肺组织损伤等并发症。复查X线片见螺钉方向、长度均满意。16例随访11～34个月。X线片显示原伤椎未进一步压缩，无内固定物松动及断裂，未出现迟发性脊髓神经损伤。结论胸椎椎弓根螺钉内固定是冶疗胸椎骨折的一种有效方法，适用于老年骨质疏松症骨折患者，固定时螺钉应贴近终板下或钉孔注入骨水泥以增加螺钉的把持力，并通过横杆组成框架式结构增加椎弓根系统的强度。

Objective To study the clinical effect of pedicle screw fixation in the treatment of elderly multiple levels osteoporotic thoracic vertebrae fractures. Methods 16 cases of multiple levels aged osteoporotic thoracic vertebrae fractures were operated by posterior long-segmental pedicle screw fixation, of which 6 involved 2 segments injuries, 6 involued 3, and 4 involded 4. Results Spinal cord, blood vessels, membrana pleuralis or lung tissue injury wasn＇t found. The direction and length of the screws were satisfied in the postoperative X-films. All cases were followed up for 11 - 34 months, the X-ray films showed there was no screw looseness or breakage of the internal fixation, or loss of the spinal height of the injuried vertebrae. Delayed spinal cord injury wasn＇t found. Conclusions Pedicle screw fixation is an effective way for treating thoracic vertebrae fractures, and it is also applicable to elderly osteoporotic patients. The stability of instruments should be enhanced by injecting bone cement into the screw holes and driving screw under terminal plate, and forming framed-structure with transverse rods in the operation.