保留后韧带复合体及伤椎固定在胸腰椎骨折中的应用

Posterior ligamentous complex and pedicle fixation for the treatment of thoracolumbar fractures

目的探讨保留后韧带复合体及伤椎固定治疗胸腰椎骨折的可行性。方法对40例胸腰椎骨折患者于伤后1周内行后路保留后韧带复合体椎管减压椎弓根螺钉复位固定术。全部病例随访6个月～2年,术后根据临床(丹尼斯疼痛量表,Frankel分级)、影像学(骨折椎体度压缩百分比,后凸畸形指数,内植物松动或断裂)、功能(丹尼斯工作量表)标准评估治疗效果。结果疼痛度:23例(57.5%)I度疼痛,12例(30%)II度疼痛,2例(5%)III度疼痛,2例(5%)IV度疼痛,1例(2.5%)V度疼痛。Frankel分级:20例维持E级,14例由D级恢复至E级,6例由C级恢复至D级。骨折椎体高度压缩百分比由术前的(29.12±11.47)改善为(21.9±10.02);后凸畸形指数术前为【(20.81±6.23)°】,术后为【(10.72±4.41)°】。将术后的骨折椎体高度压缩百分比及后凸畸形指数同术前进行比较,两者差异均具有统计学意义(P值分别为0.006和0.002)。所有病例未见内植物松动或断裂。工作能力:26例(65%)具有I级工作能力,10例(25%)具有II级工作能力,4例(10%)具有III级工作能力。结论保留后韧带复合体及伤椎固定治疗胸腰椎骨折在操作技术上是可行的,可有效恢复椎体高度,改善后凸畸形。

Objective To explore the feasibility of reservation of posterior ligamentous complex and using pedicle fixation at the level of the fracture for the treatment of thoracolumbar fractures. Methods Forty cases suffering from thoracolumbar fractures between January 2006 and January 2008, were reviewed , who aged 22 to 68 years （average 45 years）. All patients were submitted to surgical treatment by reservation of posterior ligamentous complex and using pedicle fixation at the level of the fracture within one week posttrauma . The patients were followed up for 6 months to 2 years （average 15 months） after surgery and assessed on the basis of clinical （pain, neurological deficit）, radiographic （Farcy＇s sagittal index of the fractured segment, relation between traumatic vertebral body height and the adjacent vertebrae （compression percentage）, rupture or loosening of the implants） and functional （Dennis work scale） criteria. Results Painassessment revealed that 23 patients （57.5%） had no pain, 12 （30%） had occasional pain, 2（5%） moderate pain, 2 （ 5%） moderate to severe pain, and 1（2.5%） severe pain. According to the classification of Frankel et al, 20 patients maintained as Frankel E and 14 patients changed from Frankel D to Frankel E, 6 patients from Frankel C to Frankel D. The compression percentage of the fractured vertebral body ranged from 9.8 to 60 （mean 29.12 ± 11.47） during the preoperative period, from 7 to 60 （mean 21.9± 10.02） during postoperative period. There was a statistically significant difference between the preoperative and postoperative values. The mean value of Farcy＇s sagittal index of the injured vertebral：the segment was （20.81± 6.23）°（range 10°to 34°） during the preoperative period, （10.72± 4.41）° （range 5°to 21°） during the immediate postoperative period. There was a statistically significant difference between the postoperative and the preoperative values. All patients had no rupture or loosening of the implants. Denis scale showed that 26 patients （65%） returned to the job they held before the accident, 10 patients （25%）were able to return to previous employment （sedentary） or return to heavy labor with restrictions ,4 patients （10%） unable to return to previous employment but worked full time at new jobs. Conclusions The procedure of reservation of posterior ligamentous complex and using pedicle fixation at the level of thefracture is practical, effectively regains the height of the fractured vertebral body and corrects kyphosis for the treatment of thoracolumbar fractures.