椎弓根螺钉内固定间接减压治疗胸腰椎骨折疗效观察

Indirect decompression and pedicle screw fixation for thoracolumbar vertebral fracture

目的探讨经椎弓根螺钉内固定间接减压治疗胸腰椎骨折的疗效。方法32例胸腰椎骨折患者中,17例以4枚椎弓根螺钉固定伤椎上下相邻椎体,15例以6枚椎弓根螺钉固定含伤椎及相邻上下椎体,对患者术前术后的椎体高度、矢状径Cobb角、椎管矢状径占有率、神经功能Frankel分级变化等指标进行测量并随访。结果所有患者获4～42个月随访,伤椎平均高度由术前(43.2±1.8)%恢复至(91±2.0)%,矢状面Cobb角由术前(24.2±3.0)°恢复至(5±1.0)°,椎管内矢状径占有率由(60.2±8.7)%增到(85.5±12.8)%。神经损伤术后Frankel分级:A级2例无恢复;B级2例恢复至E级1例,1例无恢复;C级5例恢复至D级1例,E级4例;D级10例恢复至E级9例,1例无恢复。无死亡或神经损伤加重病例。1例螺钉松动,1例螺钉断裂。结论用椎弓根钉复位、内固定、间接减压治疗胸腰椎骨折具有创伤小、出血少、手术时间短、脊柱稳定性好、有效矫正及预防脊柱后凸畸形、手术并发症低等优点。

Objective To observe the effect of indirect decompression and pedicle screw fixation or thoracolumbar vertebral fracture. Methods 32 cases with thoracolumbar vertebral fractures were recruited, of which 17 cases were undergone adjacent two vertebrae transpedicle fixation with 4 pedicle screws, while the other 15 cases were fixed with 6 screws including the lesioned vertebra. Several parameters （pre-operation and post-operation） were detected for value： height of fractured vertebra, encroachment rate of spinal canal, the Cobb＇s angle on sagittal plane, the Frankel grade of nerve function. Results The patients were followed up for 4 - 42 months. The height of the fracture verte- bra was restored from （43.2 ± 1.8 ） % to （91 ± 2. 0） % ; the Cobb＇s angle was from （ 24. 2 ± 3.0）° to （5 ± 1.0）° ; the length of the vertebral canal along the sagittal plane from（ 60. 2±8.7 ） % to （ 85.5 ± 12. 8 ） %. According to the Frankel grading system, patients with partial nerve injury were recorded. Among the cases, 2 cases of grade A had no sign of recovery, 1 of 2 cases of grade B to grade E and the other was not recovered ; l of 5 cases of grade C to grade D, the other 4 cases to grade E; among 10 cases of grade D, 9 to grade E and 1 had no sign of recovery after treatment. Among these cases, nerve injury aggravation was found. No one died of the operation. 1 got screw loosening and 1 got screw breakage. Conclusions Indirect reduction, decompression, and fixation with pedicle screw to treat thoracolumbar vertebral fracture have several advantages： less trauma, less blood loss, less complications and shorter operation time with more stable vertebral column, which can rectify or prevent kyphosis effectively.