后路单节段椎弓根钉复位固定治疗创伤性胸腰椎骨折

Treatment of traumatic thoracolumbar fracture with posterior monosegmental pedicle screw instrumentation

目的探讨用后路单节段椎弓根钉复位固定治疗胸腰椎骨折的可行性和疗效。方法2003年9月-2006年10月，我科共行单节段椎弓根钉骨折椎固定复位治疗胸腰骨折患者70例，其中男50例，女20例；平均年龄39、7岁。骨折按A0分类法分型：A型54例，B型16例。术中将两对椎弓根钉置入骨折椎与相邻正常椎中，复位固定，原位取骨行椎间关节融合。结果手术用时平均87min，术中出血量平均165ml，切121长度7～10cm。46例获得1年以上随访，平均随访时间18．6个月（12—35个月），无一例内固定断裂或松动，全部获得骨性融合。术中及术后骨折椎的椎体压缩程度和节段后凸角度与术前相比明显改善（P〈0.01），且术后3，6和12个月骨折椎椎体压缩程度和节段后凸角度的纠正与术中相比无明显丢失（P〉0.05）。结论经骨折椎单椎间复位固定融合术治疗胸腰椎骨折创伤小，脊椎运动功能单位的丢失更少且不易发生内固定松动或折损，可用于多数胸腰椎骨折。

Objective To explore the feasibility and efficacy of posterior monosegmental pedicle screw instrumentation in treatment of thoracolumbar fractures. Methods From September 2003 to October 2006, 70 patients （50 males and 20 females, at mean age of 39.7 years） with thoracolumbar fractures were treated with monosegmental pedicle screw instrumentation in our department. According to the AO classification, 54 patients with type A fractures and 16 with type B. Reduction and intervertebral fusion were achieved through fixation of the injured vertebrae and the adjacent normal vertebrae with 2 pairs of transpedicular screw. Results The average operation duration was 87 minutes, with average intraoperative blood loss of 165 ml. The length of incision ranged from 7 cm to 10 cm. Forty-six patients were followed up successfully for 12-35 months （average 18.6 months）. All patients achieved bone fusion with no implant failure. The vertebral compression degree and segmental kyphotic angle were significantly improved after surgery （P 〈 0.01 ）. The vertebral body height and segmental kyphotic degree at 3, 6 and 12 months following surgery did not significantly lose compared with intraoperative ones （P 〉 0.05）. Conclusion With the advantages of minor invasion, less vertebral motion segment loss and implant failure, monosegmental pedicle screw instrumentation can be applied to treat multiple thoracolumbar fractures.