经后路椎弓根固定治疗胸腰椎骨折术后畸形分析

Post-operative deformity after posterior approach vertebral pedicle fixation in treatment of thorac-lumbar fracture

[目的]分析经后路椎弓根固定治疗胸腰椎骨折术后畸形的原因。[方法]收集总结了2000年10月～2005年11月住院治疗的胸腰椎单节段骨折患者32例,其中压缩型骨折5例,爆裂型骨折27例;骨折节段为T11者2例,T12者11例,L1者15例,L2者3例,L3者1例。根据X线片及CT矢状位判定伤椎有无上、下终板骨折;根据公式计算伤椎损伤平均高度、伤椎后凸Cobb′s角。术前有15例患者存在伤椎上位终板骨折塌陷,6例存在上下终板均骨折塌陷,11例上下终板均无骨折塌陷。分别测量并记录其手术前、手术后及随访时伤椎的平均高度、后凸Cobb′s角。[结果]所有患者获10～56个月(平均23个月)随访。将术前病情按终板无骨折、上终板骨折、上下终板均骨折分为三级,评价术前病情与随访时伤椎平均高度和随访时伤椎Cobb′s角的相关性。得到术前病情与随访时伤椎高度的Spearm an相关系数为r=-0.562(P=0.001),术前病情与随访时伤椎Cobb′s角的Spearm an相关系数为r=0.641(P=0.000)。结果表明,术前病情和随访时伤椎平均高度之间存在负相关关系,病情越重,术后伤椎高度丢失越多;术前病情与随访时伤椎Cobb′s角之间存在正相关关系,病情越重,术后畸形角度越大。[结论]后路椎弓根固定治疗胸腰椎骨折术后出现再次畸形的程度与伤椎术前上下终板损伤程度有关。对于上下终板损伤的患者,后路复位经椎弓根固定的同时,需要联合前方植骨支撑、伤椎内部撑开复位加植骨以及加强固定。

[ Objective] To analyze the factors of post-operative deformity after posterior approach vertebral pediele fixation in treatment of dorso-lumbar spinal fractures. [ Method] Between 2000.10 ～ 2005.11,32 patients of single dorso-lumbar spinal fracture were hospitalized, compressive type 5 eases,explosive type 27 eases. T11 12 eases, T12 11 eases, L1 5 eases,L2 3 eases, L3 1 ease. The patients were devided into 3 groups according to the severity of related ehondral plates injuly, group 1 ： without ehondral fracture 11 cases, group 2： with upper ehondral plate fracture 15 eases, group 3： with both upper and lower ebondral plate fractures 6 eases. By the formula to measure the average height of fractured vertebral body and its kyphotie Cobb′ angle before operation, after operation and at time of follow-up,and calculate the result stastieally. [ Result] All 32 patients were followed-up for 10 ～56 months （average 23 months）. The results indicated that the patient＇S preoperative condition was negatively correlated with the average vertebral height which is followed-up. The worse condition was, and the greater loss of postoperative vertebral height was. Furthermore,the patient＇s situation before operation had a positive correlation with the Cobb′s angle of vertebral followed-up. When the patient＇s condition was worse, the postoperative angle of deformity was larger. [ Conclusion ] Posterior approach vertebral pedicle fixation in treatment of dorso-lumbar spinal fractures may result in reccurence of vertebral deformity, which is related to the severity of injury of vertebra and its chondral plates, so that to those patients related with chondral plates injuries, the vertebral pedicle fixation should be combined with anterior bone grafting, or with bone grafting into vertebral body after reduction.