经骨折椎椎弓根固定治疗胸腰椎爆裂骨折

Treatment of thoracolumbar burstfractures with fixation through the pedicle of fractured vertebra

目的 分析和探讨骨折椎椎弓根固定治疗胸腰椎爆裂性骨折的可行性及临床疗效。方法 回顾性分析我科自2001年12月-2007年10月收治的64例单锥体胸腰椎爆裂性骨折患者的临床资料,其中单纯行跨骨折椎的4钉固定术（A组）34例,包括骨折椎椎弓跟固定的6钉固定术（B组）30例。随访12-36个月（平均18.3个月）分别从病人骨折椎前缘高度、失状面Cobb角、神经功能恢复、内固定失败率（断钉,断棒及退钉等）及腰背痛方面进行评价。结果 虽然两组骨折椎前缘高度和失状面Cobb角的即刻改善无明显差别（P〉0.05）,但B组的骨折椎前缘高度和失状面Cobb角均优于A组（P〈0.05）。两组的神经功能评定比较差异无统计学意义。B组较A组有较低的腰背疼痛及内固定失败率。结论 经骨折椎椎弓根固定治疗胸腰椎爆裂性骨折是切实可行及有效的方法,值得临床探讨应用。

Objective To analyze and investigate the feasibility and clinical therapeutic efficacy of reduction and fixation through the pedicle of fractured vertebra in treatment of thoracolumbar burst fractures. Methods Clinical data of 64 cases of level thoracolumbar burst fracture in our department from December 2001 to October 2007were retrospectively analyzed. All the cases were followed up for 12 to 36 months（18.3 months on average）,and two groups were comparative analyzed from five aspects, that is fractured vertebra height, the Cobb＇ angle, nerve functions,internal fixation failure, and back pain. Results While the fractured vertebral height and the Cobb＇s angle of two groups had no significant difference immediately（P〉0.05）,B group was obviously better than A group（P〈0.05）,The nerve functions of two groups hadn＇t significant difference, and B group had lower rates of back pain and internal fixation failure. Conclusions Reduction and fixation through the pedicle of fractured vertebra was an effective therapeutic option to treat the thoracolumbar burst fractures and deserved clinical study and expansion.