后路椎弓根钉治疗多节段胸腰椎骨折

Treatment of multiple fractures of the thoracolumbar spine through posterior approach and pedicle screw fixation

目的探讨后路椎弓根钉内固定手术治疗多节段胸腰椎骨折的指征和治疗效果。方法经后路切开复位，椎弓根钉内固定治疗多节段胸腰椎骨折16例，其中相邻节段椎体骨折10例，距1节段椎体骨折4例，跨2节段椎体骨折2例。结果经12～36个月随访，平均21．5个月，Cobb角度术前10°～37°，术后恢复到0°～9°；椎体高度术前10％～60％，术后恢复到88％～99％。术后神经损伤大部分有所改善或恢复正常，骨折椎体高度无明显丢失，内固定物无松动、断裂。结论胸腰椎多节段骨折造成椎体严重不稳，需及时手术治疗，经后路椎弓根钉棒系统内固定和有限的椎管减压，可重建脊椎的稳定性，促进受损神经功能的恢复。

Objective To investigate the operative indications and the therapeutic effect of the pedicle screw fixation used for treating multiple fractures of the thoracolumbar spine. Methods 16 cases of multiple fractures of the thoracolumbar spine were chosen to be treated by open reduction through posterior approach and pedicle screw fixation. 10 cases were the fractures involved adjacent segments,4 cases were the fractures with one intact vertebral segment between them,2 cases were the fractures with two intact vertebral segments between them. Results The patients were followed up for 12 - 36 months, with an average of 21.5 months. After the operations, function of most of the injured nerves had been improved or restored. The vertebral height of the fractured segment showed no significant loss. The materials of internal fixation found no loosening or fracturing at the end of follow-up. Conclusion Fractures of multi-segment of thoracolumbar vertebrae can cause serious instability and are required for timely treatment. The method of the internal fixation with pedicle screw-rod fixation system through posterior approach, followed by limited decompression,can reconstruct the stability of the vertebrae and promote the recovery of the impaired neurological functions.