急诊后路椎弓根钉棒系统间接复位治疗胸腰椎压缩及爆裂骨折

Emergency Operative Treatment on Thoracolumbar Compression or Burst Fractures Using Pedicle Screw Instrument Through Posterior Approach and Indirect Reduction

目的观察急诊后路椎弓根钉棒系统间接复位治疗胸腰椎压缩及爆裂骨折的疗效。方法选择外伤后4d内胸腰椎压缩或爆裂骨折急诊患者53例(男性34例,女性19例),经后路行椎弓根钉棒系统复位、椎管间接减压及植骨内固定术。对患者术前、术后伤椎高度、后突角、椎管矢状径变化率、神经功能Frankel分级变化进行随访。结果所有病例获得2周内随访,其中47例获得1年以上随访。术后伤椎平均高度由术前的42.28%恢复到93.46%;平均后突角由术前的26.44°恢复到17.73°;平均椎管矢状径由63.14%恢复到78.55%。术后各随访期除5例完全性脊髓损伤患者无恢复外,其余脊髓、马尾损伤患者神经功能均获得Frankel分级1级以上恢复。随访患者中无1例出现晚发性脊髓损伤及腰背痛;3例出现部分螺钉松动或断裂,但均无特殊不适,亦无椎体高度丢失。结论对胸腰椎压缩、爆裂骨折在严格掌握手术适应证的前提下,急诊经后路行椎弓根钉棒系统间接复位、减压及内固定术,具有创伤小、手术时间短、手术操作简单等优点,且骨折复位及脊髓、神经功能恢复疗效肯定。

Objective To observe the clinical effect of emergency operative treatment on thoracolumbar compression or burst fractures using pedicle screw instrument through posterior approach and indirect reduction. Methods 53 acute thoracolumbar compression or burst fractures cases injured within 4 days were accepted the emergency operation of indirect reduction, decompression and fixation using pedicle screw instrument through posterior approach. The mean percentage of traumatic vertebral body height, sagittal diameter of spinal canal, degrees of kyphosis and Frankel scoring of nerve function were evaluated before and after operation. Results All cases received two weeks following-up, 47 cases had more than one-year following-up. The mean percentage of traumatic vertebral height restored from 42.28 % （pre-operation） to 93.46 % （post-operation） ; the mean degrees of kyphosis recovered from 26.44% （pre-operation） to 17.73° （post-operation）; the mean percentage of sagittal diameter of spinal canal changed from 63.14 % （pre-operation） to 78.55% （post-operation）. All but cases with completely spinal cord injury got more than one grade nerve functional restoration. Neither later spinal cord injury nor back pain existed among the patients. Three cases emerged partial internal fixation device failure, but neither symptoms nor abnormality correction missed. Conclusion Emergency operation using pedicle screw instrument through posterior approach is a feasible and confirmatory choice in treatment of the acute thoracolumbar compression or burst fractures if the cases are selected properly.