经椎弓根短节段固定治疗胸腰椎爆裂性骨折

Short-segment pedicle screw internal fixation for thoracolumbar spine burst fractures

目的探讨后路短节段固定治疗胸腰椎爆裂性骨折的方法。方法应用短节段钉棒系统经椎弓根复位、固定,Ⅰ期植骨融合,治疗胸腰椎爆裂性骨折32例。有神经损伤或压迫症状者,术中椎管造影,如确定后突骨块复位不满意者,行半椎板切除,椎管扩大减压,椎体间植骨。结果术后29例基本解剖复位,3例大部分复位,并恢复了正常的脊柱力线。不全瘫者10例术后均有不同程度的功能恢复,完全瘫者3例,2例功能无恢复。26例经随访1～3年,矫正角度基本未丢失,未出现断钉、脱棒等现象,23例植骨融合,融合率达88.5%。结论该手术方法复位满意,固定可靠,对椎管的间接减压是有效的,并最大限度地保留了未损伤的运动节段功能,但患者需另取髂骨,部分患者供区遗留顽固性疼痛。

Objective：To study the method of treating burst fractures of Thoracoltunbar spine by use of Short-Segment pedicle screw internal fixation. Methods： 32 cases of burst fractures in Thoracolumbar spine were treated with Short-Segment pedicle screw internal fixation system, posterior reduction, stabilization through the pedicle screw fixation and bone graft in the operatlon. Spinal canal myelography were used to the patients who were of obstruction of spinal canal and compression against spinal nerve root,if reduction of the fracture fragment was unsatisfactory,were given the treatments of enlarged laminectomy and intrabody bone graft. Results： The postoperative results showed that 29 patients obtained anatomical reduction; 3 cases were reduced generally and its spinal force-line recovered;10 cases of incomplete paralysis recovered to a certain degree after operation, 3 cases of complete paralysis,2 of them did not recover.26 cases were followed-up ranging from 1-3 years,no loss of corrective angle was found,no screw broke off and bar took off,23 cases of them bone graft recovered,the rate of 88.5%. Conclusion： The Short-Segment pedicle screw internal fixation system is reliable in reduction, fixation and decompression,also ,it can reserve the functions of intact segments maximally,but needs iliac bone for graft,which some of them leave over pains.