终板法置钉单运动单元内固定治疗胸腰椎骨折

The clinical study of monosegmental internal fixation by end-plate method for the treatment of thoracolumbar fractures

目的:探讨自行设计的终板法置钉单运动单元内固定治疗胸腰椎单椎体骨折的可行性和临床疗效。方法:49例胸腰椎单椎体骨折患者,其中压缩型17例,爆裂型28例,骨折脱位型4例;T117例,T1213例,L120例,L29例。脊髓神经功能按Frankel分级,A级6例,B级8例,C级16例,D级12例,E级7例。采用终板法置钉技术,将椎弓根螺钉分别置入伤椎未骨折部分及与伤椎骨折终板相邻的椎体中,并行伤椎椎体内及椎间植骨。比较术前、术后的伤椎压缩百分比、后凸Cobb角、椎管狭窄率,观察术后腰痛和腰椎活动情况。结果:49例患者手术均获成功,手术时间120～180min,平均150min;术中出血500～800ml,平均670ml。术后所有患者骨折椎体均得到良好复位,术前的伤椎压缩百分比、后凸Cobb角和椎管狭窄率分别为(41.8±9.5)%、(21.3±5.2)°、(47.5±12.8)%,术后分别为(4.2±4.7)%、(3.3±3.7)°、(6.1±4.9)%,术前、术后差异均有显著性(P<0.05)。随访9～32个月,平均17.9个月,4～6个月植骨均获得骨性融合,9～12个月复查X线片无明显矫正角度丢失,与术后比较无显著性差异(P>0.05)。42例术前脊髓神经损伤患者中,33例术后神经功能得到不同程度的恢复,9例术后神经功能无变化。随访期内无腰背部顽固性疼痛、腰椎活动受限、内固定失败等并发症。结论:终板法置钉单运动单元内固定治疗胸腰椎单椎体骨折可重建骨折脊柱的即刻稳定性,近期随访效果满意。

Objective：To study the feasibility and clinical effect of the treatment for a single vertebral fracture of thoraeolumbar spine with monosegmental internal fixation by end-plate method.Method：49 patients with a single vertebral fracture of thoracolumbar spine were studied,among them the fracture type included 17 cases of compression fracture,28 csaes burst fracture,4 cases fracture and dislocation,and the fracture sites were T11 in 7 cases,T12 in 13 cases,L1 in 20 cases,L2 in 9 eases.The spinal cord function was classified according to Frankel＇s scale as grade A 6 eases,grade B 8 cases,grade C 16 cases,grade D 12 cases, grade E 7 cases.All of them were treated with monosegmental internal fixation,and intervertebral grafting.The pedicle screws were implanted in the unaffected part of the fractured vertebra and the normal vertebra adja- cent to the fracture end-plate.The pre- and post-operative height of the fracture vertebrae,the Cobb＇s angle, the spinal canal stenosis rate were compared,and low back pain and the lumbar motion after operation were observed.Result：All 49 patients had successful surgery,the operation time was 120-180 minutes（average 150 minutes）,the blood loss was 500-800ml （average 670ml）.All cases achieved a good reduction,the com- pression rate,Cobb＇s angle and spinal canal stenosis rate were from preoperative （41.8±9.5）%,（21.3±5.2）°, （47.5±12.8）% to postoperative （4.2±4.7）%, （3.3±3.7）°, （6.1±4.9）%.These changes had significant difference statistically before and after operation （P〈0.05）.All cases were followed-up 9-32 months （average 17.9 months） ,strong bone fusion was achieved in 4-6 months,at 9-12 months follow-up,rechecked X-ray films re- vealed the loss of reduction was not obvious,difference withou statistical significance （P〉0.05）.Of 42 cases with incomplete spinal cord injury,33 cases had some improvement of the spinal cord function,only 9 cases had no any change,no refractoriness low back pain,limitation of lumbar motion and failed internal fixation occured.Conclusion：Monosegmental internal fixation by end-plate method can provide the instant stability,and its clinical effects are satisfied by short term follow-up.