椎弓根螺钉单一运动节段内固定治疗胸腰椎单椎体骨折

Treatment of single level of thoracolumbar fracture with posterior transpedicular instrumentation

目的:探讨椎弓根螺钉单一运动节段内固定结合椎间植骨治疗胸腰椎单椎体骨折的手术适应证和临床疗效。方法:对21例胸腰椎单椎体骨折患者采用经椎弓根单一运动节段内固定结合椎间植骨治疗,术前、术后1周及术后9个月摄X线片,测量伤椎椎体成角、上下终板成角及椎体前缘高度与正常高度的比值,了解术后骨折复位情况以及随访期间内固定有无失败和复位丢失情况。按ASIA 2000分级标准对17例脊髓神经损伤患者评估术前脊髓神经损伤程度及术后9个月脊髓神经功能改善情况。结果:随访9～26个月,平均14.2个月,无内固定失败,椎间植骨融合良好。术后1周及术后9个月伤椎椎体成角、上下终板成角、椎体前缘高度与正常高度的比值较术前均明显改善(P<0.05);术后9个月与术后1周比较无显著性差异(P>0.05)。17例脊髓神经损伤患者术后脊髓神经功能均有不同程度的恢复。结论:采用经椎弓根单一运动节段内固定结合椎间植骨治疗胸腰椎单椎体骨折创伤较小、固定单位最少,能有效地防止复位丢失,是治疗胸腰椎单椎体骨折的有效方法。

Objective-To evaluate the indication and clinical outcome of posterior transpedieular instrumentation on single-segment of thoracolumbar fracture.Method：21 patients with single-segment of thoracolumbar fracture were treated with posterior transpedicular instrument and intervertebral bone graft.Radiological outcomes measured before operation,at 7th day and 9th month after operation,which included the vertebral angle,the superior-inferior endplate angle and the ratio of anterior border height to the normal height.The radiographs obtained during the follow-up period were also analyzed to find if there were instrument failures and loss of correction .The grade of spinal cord injury before operation and improvement of neurological function during the 9th month post-operation were evaluated in 17 cases,according to the standards of ASIA amended in 2000.Result：21 patients were followed up for 9 to 26 months （mean,14.2 months ）.There was no failure of the instrumentation during the follow-up period and bony fusion were observed in all 21 cases with intervertebral bone grafting.The operative reduction had an satisfactory effect on the vertebral angle,the superior-inferior endplate angle and the ratio of anterior border height to the normal height at 7th day and 9th month after operation,which showed statistically significant differences compared with pre-operational counterpart （P〈 0.05）.There were no statistically significant difference between the 9th month after operation and 7th day after operation （P〉0.05）.The loss of correction was not significant during the follow-up period.All patients with spinal cord or nerve injury got one or two grade recovery of neurological function.Conclusion：This operation can prevent instrument failure and loss of correction;moreover,which has the advantages of less invasive,less movement segment loss,etc.It is an effective surgical method.