单纯椎弓根钉置入复位固定不行植骨融合治疗胸腰椎爆裂骨折63例

Thoracolumbar burst fractures treated by transpedicular instrumentation without fusion in 63 cases

目的：观察单纯椎弓根钉置入复位固定不行植骨融合对无明显神经损伤的不稳定性胸腰椎爆裂骨折的疗效。方法：回顾性分析解放军第一○一医院骨科收治的行单纯椎弓根钉置入复位内固定而不行植骨融合的无明显神经损伤胸腰段椎体爆裂骨折患者63例,其中40例行AF内固定,16例行Tennor钉棒固定,7例行Diapason钉棒固定。所有患者于椎弓根钉置入前后、及置入后24个月随访时拍正侧位X射线平片以及行损伤椎体及上下相邻椎体的CT检查（其中63例获得了术前、28例术后即刻、以及25例术后24个月时的CT资料）。于侧位片测量Cobb角表示成角畸形程度;测量椎体前缘高度丢失表示椎体前部塌陷程度;于CT片上测量椎管正中矢状径表示椎管占位程度;临床疗效采用Greenought等的下腰痛评分法评定。结果：所有患者最后随访时均为24个月,平均住院时间13.4d,住院至手术平均时间为3.8d,51例在术后8－12个月取出内固定,取出内固定后住院平均9.4d。末次随访时根据下腰痛评分标准优46例,良9例,中5例,差3例,优良率88%。Cobb角置入前平均20.1°,置入后平均6.2°,最后随访时11.9°;椎体前缘高度丢失置入前平均49.1%,置入后为17.4%,最后随访时为20.4%;椎管正中矢状径椎弓根钉置入前（n=63）平均49.8%,置入后（n=28）平均78.1%,最后随访时（n=25）平均91.7%;有5例（8%）由于内固定部件断裂致内固定失败;最后随访时影像学参数（Cobb角、椎体前缘高度和椎管正中矢状径）与下腰痛评分无明显相关性。结论：单纯椎弓根钉置入复位固定不行植骨融合对无明显神经损伤的不稳定性胸腰椎爆裂骨折疗效满意,对这种类型骨折治疗常规行后外侧融合是不必要的。

OBJECTIVE： To determine the therapeutic effect of transpedicular instrumentation without fusion on patients with thoracolumbar burst fractures. METHODS： A total of 63 patients with thoracolumbar burst fractures （the inclusion criteria was neurologically intact spine with a kyphotic angle 20° and/or decreased anterior vertebral body height 50%） who were treated with transpedicular instrumentation without fusion were studied, including 40 cases treated by AF internal fixation, 16 cases by Tennor screw-rod fixation system and 7 cases by Diapason screw-rod fixation. All patients underwent a radiological and clinical assessment （including the loss of kyphotic angle, decreased anterior vertebral body height, the midsagital diameter of the canal and the Low Back Outcome Score） preoperatively, postoperatively and after 24 months. The deformity of angulation was measured by Cobb angle. RESULTS： All patients were followed for a 24 months, with average stay of 13.4 days. There were averaged 3.8 days from admitted to operation, and the internal fixation was removed within 8-12 months in 51 cases, followed a 9.4-day hospital stay. According to low back outcome score, 46 patients achieved excellent, 9 good, 5 fair and 3 poor, with excellent and good rates of 88%. The Cobb’s angle was 20.1° preoperatively, 6.2° postoperatively, and 11.9° after 24 months. The average lose of anterior vertebral body height was changed from 49.1% preoperatively to 17.4% postoperatively, which was 20.4% after 24 months. The midsagittal diameters was 49.8% （n=63） preoperatively, 78.1% （n=28） postoperatively, and 91.7% （n=25） after 24 months. The implant failure occurred in 5 patients. The radiographic parameters had no associativity to the outcome of LBOS. CONCLUSION： Transpedicular instrumentation without fusion is conductive to treating burst fractures of the thoracolumbar spine without nerve injury. The routine posterior or posterolateral fusion is unnecessary in the operative management of these fractures.