椎弓根钉内固定联合伤椎自体骨植骨治疗胸腰椎爆裂性骨折

Transpedicular Fixation Combined with Autogenous Bone Grafting in Treatment of Thoracolumbar Burst Fractures

目的：探讨经椎弓根钉内固定联合伤椎自体骨植骨治疗胸腰椎爆裂性骨折的，陆床疗效。方法：2003年12月-2007年6月对本院骨科38例胸腰椎爆裂性骨折患者采用后路椎弓根钉内固定联合伤椎自体骨植骨治疗。所有患者术前、术后、随访均行X线及CT检查，X线测量伤椎椎体前缘高度值、Cobb’s后凸角，CT测量椎管占位比。同时观察植骨融合和脊髓神经功能恢复情况。结果：患者均获得骨性愈合，52．63％（20／38）患者椎体前缘高度恢复至正常值的95％以上，平均恢复至（89．73±9．01）％；术后、末次随访Cobb’s角[（6．74±4．78）°，（7．45±5．04）°]均较术前（23．96±5．48）°减少（P〈0．05），椎管占位比[（16．29±11．38）％，（12．38±8．11）％]也较术前（34．23±19．65）％减少；所有患者脊柱生理曲度无丢失，内固定无松脱断裂，不完全损伤的患者神经功能较术前均有1～2级改善，随访疗效满意。结论：后路经椎弓根钉内固定联合伤椎自体骨植骨治疗胸腰椎爆裂性骨折效果确切，椎管占位恢复好，前中柱重建稳定，后柱固定牢固，是一种治疗胸腰椎爆裂骨折的有效方法。

Objective： To explore the outcomes of transpedicular fixation combined with autogenous bone grafting in treatment of thoracolumbar burst fractures. Methods： From Dec 2003 to Jun 2007, thirty-eight patients with thoracolumbar burst fracture were treated with transpedicular fixation combined with transpedicular intracorporeal grafting and were followed up thereafter. Before and after surgery and at follow-up, these patients were evaluated with X-ray for anterior heights of the injured vertebra （AHIV） and Cobb＇ s angle, and with CT scans for sagittal canal diameter （SCD）. The data collected were analyzed by statistical software SPSS 10.0. We also observed the fusion of the grafted bone and neurofunctional recovery of the spinal cord. Results ： Fusion of the grafted bone was achieved in all 38 patients. AHIV showed good recovery to more than 95% [mean（86.73±9.01）% ] of the normal value in 52.63% （20/38） of the cases. Shortly after surgery and at the last interview, Cobb＇s angle appeared smaller [（6.74±4.78）° and （7.45±5.04）° vs （23.96±5.48）° preoperatively （in degrees）] and the sagittal canal diameter was reduced [（16.29±11.38）% and 02.38±8.11）% vs （34.23±19.65）% preoperatively）]. There were no loss of spinal curvatures, no displacement or rupture of the internal fixation. In patients with incomplete injury, neural functions showed 1 to 2 grade improvement compared with the findings before operation. Conclusion： Fixation with transpedicular short segment fixation and intracorporeal grafting resulted in evidenced outcomes, with reliable recovery of SCD, stable reconstruction of the anterior and middle columns and secured fixation of the posterior column. Therefore, this technique can be an effective solution for thoracolumbar vertebral fractures.