椎弓根螺钉跨节段固定单节段融合治疗胸腰椎骨折

Treatment of thoracolumbar vertebral fracture with transpeducular posterior internal fixation and rod-long and fuse-short method

目的探讨有限减压、椎弓根螺钉跨节段固定单侧椎间隙椎间植骨融合治疗胸腰椎骨折的临床疗效。方法回顾性研究应用该技术治疗的41例胸腰椎骨折患者,观察植骨融合及复位情况、椎管减压情况、神经功能恢复情况,及矫正丢失、顽固性腰痛及腰椎活动受限等并发症发生情况。结果平均随访12.5个月,所有患者均达到坚强骨性融合,无内固定松动断裂,均得到满意的复位,复位率达95.7%,(P<0.01),33例获得2年以上随访,矫正高度平均丢失1.7%(P>0.05);cobb’s角平均矫正22.7°(P<0.01),平均丢失3.2°(P>0.05);术后神经功能均得到不同程度的恢复,未出现顽固性腰痛、腰椎活动受限等并发症,临床疗效明显优于两节段固定融合。结论只要手术适应症选择正确,该术式不但能达到有效减压复位、坚强融合内固定的目的,而且能有效避免顽固性腰痛、腰椎活动受限及远期矫正角度丢失后凸畸形复发等并发症的发生。

objective To study the feasibility and clinical effect of the treatment of thoracolumbar vertebral fracture with limited decompression,bestride segment internal fixation and mono-ntervertebral space fusion. Methods Retrospective study of 41 patients with thoracolumbar fracture who were treated with this technique,to observe the fusion of bone graft and reduction,decompression of spinae canal,nerve functional recovery,and the loss of rectification,low back pain,and the limitation of activity of lumbar. Results When followed up 12.5 months,all cases achieved strong bony fusion and gained satisfactory reduction,the height and Cobb＇s angle reduction rate reached 95.7% and 22.7°（P〈0.01）,no reduction loss,33 cases followed up 2 and more years,the average reduction loss of height and Cobb＇s angle were 1.7% and 3.2°（P〉0.05）,and the the nerve functional of all patients reliefed,rank-sum test P〈0.01,no refractory low back pain,limitation of motion of lumbar et al. Conclusion As long as if conneit indication was chosen,this of operation kind not only can get strong bony fusion and satisfactory reduction,but also obviously degrade the incidence rate of refractory slow back pain and limitation of motion of lumbar,and the loss of rectification et al.