经骨折椎椎弓根螺钉固定在胸腰椎骨折中的应用

Transpedicular screw fixation for thoracolumbar fractures

目的探讨经骨折椎行椎弓根螺钉固定对胸腰椎骨折复位及维持复位的可行性及效果。方法对2003年1月-2006年10月收治的43例胸腰椎骨折患者进行回顾性研究。入选标准：T12-L2单椎体骨折；骨折椎椎弓根完整；下终板无骨折。全部患者均在伤后10d内手术。骨折椎加用椎弓根螺钉固定23例（A组），其中男15例，女8例；平均年龄45岁（19～77岁）。传统4钉固定20例（B组），其中男11例，女9例；平均年龄42岁（22—67岁）。A组首先固定骨折椎与其尾侧椎，再在骨折椎与头侧椎之间撑开。结果手术前后骨折椎尾侧椎间隙前缘高度的变化A组（0．035±0．042）小于B组（0．061±0．036），差异有统计学意义（P〈0．05）。A组Cobb角的变化为（15．8±7．8）°，B组为（13．1±5．2）°，两组差异无统计学意义。34例得到平均15个月（11～24个月）的随访，末次随访时Cobb角A组平均丢失5．4°，B组平均丢失8．9°，两组比较，差异有统计学意义（P〈0．05）。A组有1例固定杆断裂，B组2例螺钉断裂。结论对部分胸腰椎骨折在骨折椎应用椎弓根螺钉可以增强后路短节段固定系统的牢固性，避免骨折椎尾侧椎间隙的过度撑开，改善应力分布，减少矫正度丢失。

Objective To evaluate the feasibility and outcome of transpedicular screw fixation in fracture reduction and maintenance of reduction for thoracolumbar fractures. Methods The clinical data of 43 patients with thoracolumbar fractures admitted to Orthopedic Trauma Hospital of Qingdao from January 2003 to December 2006 were retrospectively analyzed. The inclusion criteria were as follow ： single vertebral fracture involving T12-L2, integrated pedicle and no inferior endplate fracture. All patients received operation within 10 days after injury. Three-level fixation at fractured vertebra plus pedicle screw fixation was performed in 23 patients （Group A） including 15 males and 8 females, at mean age of 45 years （19-77 years）. Traditional two-level fixation was done on the other 20 patients （Group B ） including 11 males and 9 females, at mean age of 42 years （ 22-67 years ）. In Group A, the transpedicular screws fixing the fractured vertebra and cephal vertebra were distracted after locking the transpedicular screw of the fracture vertebra and caudal vertebra. Results The height of the anterior edge of the caudal disc in Group B was O. 035 ±0.042, greater than 0. 061 ±0. 036 in Group A, with statistical difference （ P 〈 0.05 ）. There was no statistical difference in the changes of Cobb angle after the operation between （915.8 ±7.8） ° in Group A and （13.1 ±5.2）° in Group B. 34 patients were followed up for an average period of 15 months （11-24 months）, which showed smaller Cobb angle in Group A （5.4°） compared with Group B （8.9°） （P 〈0.05）. There was one patient with screw breakage in Group A and two in Group B. Conclusion Transpedicular screws can enhance the stability of the posterior shortsegment instrumentation, avoid over-distraction of the caudal discs, improve stress distribution and lessen loss of correction for some thoracolumbar fractures.