单节段伤椎椎弓根螺钉内固定治疗胸腰段骨折

Treatment of the Thoracolumbar Spine Fracture with Posterior Monosegment Pedicle Fixation at the Injured Level

目的探讨伤椎椎弓根螺钉单节段内固定治疗胸腰椎骨折的适应证、手术方法及临床疗效。方法对17例压缩性骨折和轻度暴力骨折采用后路单节段伤椎椎弓根螺钉内固定植骨融合。患者随访6～27(平均17.5)个月,进行临床Denis疼痛评分、调查患者对手术的满意度、患者工作恢复状况及X线检查情况(包括术前、术后、随访时椎体的高度、伤椎的后凸畸形,内固定物的状况等)。结果所有患者均得到随访,按照Den is疼痛分级,P1级有12例患者无疼痛,P2级有5例患者有轻微疼痛,无需服药治疗,所有患者均对手术表示满意。神经功能均恢复至正常;X线检查术后椎体高度恢复满意,术后伤椎矫正率为96%,随访椎体高度丢失0.4 mm,丢失率为1.4%。无内固定物断裂、松动、脱出,所有病例均获得骨性融合,无假关节形成。结论选择好适应证,后路单节段伤椎内固定是治疗胸腰段骨折的有效方法之一。

Objective To evaluate the indications, clinical outcome of the treatment of thoracolumbar spine fracture with posterior transpedicular instrumentation. Methods 17 patients with thoracolumbar spine fractures underwent the surgical procedure of posterior monosegmental fixation and arthrodesis. Follow-up investigation ranged from 6 -27 months （mean： 17.5 ）, patients were assessed by clinical evaluation and radiographic study. The parameters used for clinical evaluation were the Denis pain scale and neurological evaluation by the Frankel scale. The height of the injured vertebra, kyphosis of the injured vertebral segment, and the presence of bone reabsorption around the implant were used for radiographic evaluation. Results Clinical evaluation revealed that 12 cases had no pain, 5 cases with occasional pain but no medication and all patients had a high level of satisfaction with the final results. Radiographic evaluation revealed reduction rate of the injured vertebral height was 96%, and the reduction loss rate was 1.4% at final follower-up. There was no implant break, and no signs of pseudoarthrosis were observed in any patient. Conclusion The clinical and radiographic results observed show that posterior monosegmental fixation might be an adequate and effective procedure to be used in specific types of thoracolumbar spine fractures.