胸腰段脊柱骨折后路椎弓根螺钉内固定疗效及术后椎间盘退变的评价

Adjacent dis degenerative changes following the pedicle screw fixation for thoracolumbar fracture

[目的]评价胸腰段脊柱骨折后路SF椎弓根螺钉内固定术的临床特殊疗效及术后椎间盘退变的情况。[方法]2001年7月～2003年7月间采用SF椎弓根螺钉内固定系统治疗胸腰段骨折36例,部分患者行椎管减压,横突间植骨融合。[结果]经2～5年(平均3.72年)随访,与术前比较,术后、拆除内植物前及末次随访时的Cobb′s角及椎体前、后缘高度差异均有统计学意义(P<0.01)。本组患者脊髓损伤分级评判,除1例完全性瘫痪患者术后无功能恢复外,其余患者均获得了不同程度的功能恢复。但末次随访时可见伤椎临近椎间隙不同程度的退变,其中上方椎间隙出现退变有20例,下方椎间隙有11例。[结论]胸腰段骨折SF椎弓根螺钉内固定牢靠,间接复位能使突入椎管腔内的伤椎椎体后壁满意复位,使椎管有效减压。但中期随访发现,仍存在椎间盘退变及矫正度丢失的情况,对于出现症状者可先行非手术治疗,无效时可考虑行减压、融合内固定、人工椎间盘置换等方法。但如何合理选择手术方法及内固定材料,还需进一步探讨。

[ Objective] To evaluate the efficacy and disc degeneration of the SF pedicle screw internal fixators in the treatment of thoracolumbar fractures. [ Method] Thirty-six patients were treated by SF pedicle screw intemal fixators from July 2001 to July 2003. [ Result]Thirty-six patients were followed-up for 2 - 5 years （average 3.72 years） ,Compared with preoperation, the Cobb＇s angle, anterior and posterior heights of compressed vertebral bodies of postoperation and final follow-up were significantly corrected（ P 〈 0.01 ）. Exceptone case with complete paralysis, the ASIA assessment of other 35 cases with incomplete paralysis progressed 1 to 3 grades. But at final following, there were disc degeneration in the adjacent intervertebral space. Tweaty cases happened in superior intervertebral space and 11 cases in inferior. [ Conclusion] SF pedicle screw internal fixators are reliable and effective for thoracolumbar fractures. But during the middle follow-up,the disc degeneration and thecorrected height loss are still problems. As the clinic symptom coming up, we need not operation at first, until the result is not reliable, then we may have the operation on them：just as decompression, fusion and fixation, ADL （arthroscopic disc replacement） et al.