经伤椎椎弓根螺钉内固定治疗胸腰椎爆裂骨折

Surgical treatment of thoracolumbar burst fractures with vertebral pedicle screw fixation

目的总结经伤椎椎弓根螺钉内固定治疗胸腰椎爆裂骨折的临床经验。方法1999—2007年收治70例胸腰椎爆裂骨折患者，其中男59例，女11例；年龄20—65岁。单一节段骨折66例，其中L1骨折28例，L2骨折13例，L3骨折10例，L4骨折4例，L5骨折2例，T11骨折2例，T12骨折7例；双节段骨折3例，其中T12～L1、L1-L2和L2-L3骨折各1例；三节段骨折1例，为T12～L2。神经功能按Frankel分级：A级6例，B级26例，C级14例，D级7例，E级17例。术前椎体前缘高平均32％，后凸角平均25°，术前、术后均行X线检查。内固定方式：钛板系统（DRFS）65例，钛棒系统5例（PRSS1例，USS1例，CD3例）。结果术后随访0．5～5年，平均2．3年，术后椎体前缘高度术后恢复至95％，后凸角矫正至前凸5°。术后神经功能恢复情况：A级6例，B级18例，C级19例，D级5例，E级22例。结论经伤椎椎弓根植骨螺钉内固定可以恢复脊柱生理弯曲及伤椎前缘高度，使骨折块复位，为神经功能恢复创造条件，是治疗胸腰椎爆裂骨折的一种较好方法。DRFS钢板操作简单、固定效果确切，适合伤椎内固定物的选择。

Objective To introduce the clinical experiences in surgical treatment of thoracolumbar burst fractures with vertebral pedicle screw fixation. Methods A total of 70 cases of thoracolumbar burst fractures （59 males and 11 females, with age range of 20-65 years） treated in our hospital from 1999 to 2007 were analyzed. Of them, there were 66 cases of single segment fractures （ fracture at L1 in 28 cases, at L2 in 13, at L3 in 10, at L1 in 4, at L5 in 2, at T1 1 in 2 and at T12 in 7）, 3 double segment fracture （ fracture at T12-L1 in 1 case, at L1-L2 in 1 and at L2-L3 in 1 ） and 1 triple segment fracture （ T12- L2 ）. According to Franke＇s neurological function classification, preoperative neurological function was Grade A in 6 cases, B in 26, C in 14, D in 7 and E in 17. The preoperative ratio of the height of the anterior border was 32% and kyphosis degree was 25 on average. X-ray film and CT scan were taken before and after operation. Of 70 cases, 65 were fixed with Distraction Reduction Fixation System （ DRFS）, 3 with Cotrel-Dubousset （CD） system, 1 with Plate-Rod System for Scoliosis （PRSS） and 1 with Universal Spine System （USS）. Results All cases were followed up for 0.5-5 years （ average 2.3 years）. The height of the anterior border was increased to 95% and the kyphosis corrected to 5° lordosis postoperatively. The postoperative neurological function was improved, ie, Grade A in 6 cases, Grade B in 18, Grade C in 19, Grade D in 5 and Grade E in 22 respectively. Condusions Vertebral pedicle screw fixation can achieve satisfactory clinical outcome in treating thoracolumbar burst fractures by restoring the spinal physiological curve, improving the injured vertebral body height, repositioning the bone and accelerating the recovery of neurological function. Fixation with DRFS is simple and effective, and can be applied to the internal fixation of the injured vertebrae.