后路短节段钉棒系统结合伤椎椎弓根钉固定治疗胸腰椎骨折

Treatment of thoracolumbar fractures with posterior short segment peg-stick system plus pedicle screw fixation

目的探讨后路短节段钉棒系统结合伤椎椎弓根钉固定治疗胸腰椎骨折的价值。方法本组患者33例，伤椎部位：T113例，T1211例，L110例，L29例。其中单纯压缩骨折3例，爆裂骨折30例。合并截瘫33例。对单纯压缩骨折行后路短节段钉棒系统结合伤椎椎弓根钉内固定术。对合并截瘫椎管占位明显者固定后行后路椎板减压、椎管开大术，并行小关节突及横突间植骨融合。用Frankel分级评估神经功能。结果术后33例均获随访，平均随访时间14．5个月。术后X线片示椎弓根钉位置好，伤椎复位外形好。随访期内固定无松动或断裂，无慢性腰痛，伤椎高度无丢失。33例合并不全瘫。术前Frankel级：A级1例，B级7例，C级16例，D级9例；术后Frankel分级：A级1例，B级1例，C级5例，D级10例，E级16例。结论对于胸腰椎骨折尤其是胸腰椎爆裂骨折，后路短节段钉棒系统结合伤椎椎弓根钉固定术是一种疗效可靠的内固定方法。

Objective To investigate the value of posterior short segment peg-stick system plus pedicle screw fixation in treatment of thoraeolumbar fractures. Methods There were 38 patients involving fractures at Tjl in three patients, at T12 in 11, at L1 in 15 and at L2 in nine. There were three patients with simple fractures of vertebral compression, 35 with burst fractures, 33 with thoracolumbar fractures combined with paraplegia. The patients with simple fracture of vertebral compression were treated by posterior short-segment peg-stick system plus pedicle screw fixation. While the patients with paraplegia and intraspinal occupancy were treated by posterior decompression, vertebral enlargement and bone grafting （ between zygopophysis and transverse process） after fixation. Results All patients received a follow-up for average 14.5 months, which showed accurate position of pedicle screw and fine contour of the injured vertebra after reduction, with no loosening or breakage of fixators, chronic lumbar pain or loss of the height of fractured vertebra. Of all, 33 patients were accompanied by paresis. There was one patient at Grade A, six at Grade B, 16 at Grade C and nine at Grade D before operation. But there was one patient at Grade A, one at Grade B, five at Grade C, 10 at Grade D and 16 at Grade E. Conclusions For thoraeolumbar fractures especially vertebral burst fractures, posterior short segment speg-stick system plus pedicle screw fixation is an ideal treatment method, for it has the following advantages： no obvious loss of the height of the vertebra after operation, protection of the intact intervertebral disc under the injured vertebra and minor effect on range of motion of the lumbar vertebrae.