经椎间孔椎体间融合单节段椎弓根螺钉内固定治疗胸腰椎A3型爆裂骨折

Posterior monosegmental pedicle screw fixation and transforaminal lumbar interbody fusion for type A3 thoracolumbar burst fracture

目的:探讨后路单节段椎弓根螺钉内固定结合经椎间孔椎体间融合治疗胸腰椎单椎体A3型爆裂骨折的临床疗效及其安全性。方法:2005年3月～2007年10月收治并获得随访的胸腰椎单椎体A3型(AO分型)爆裂骨折患者16例,其中T112例,T122例,L15例,L25例,L31例,L41例。术前脊髓神经功能按Frankel分级标准评定,C级1例,D级4例,E级11例。均行后路单节段椎弓根螺钉内固定结合经椎间孔椎体间植骨融合治疗,随访观察治疗效果。结果:所有手术均顺利完成,无椎弓根螺钉置入位置错误及神经血管损伤等并发症发生。手术时间90～180min,平均125min;出血量200～600ml;平均330ml。随访10～38个月,平均14.6个月,无内固定松动、断裂,椎间植骨均获得骨性融合。术后1周及末次随访时骨折节段矢状面后凸角、伤椎椎体前缘高度与预计正常高度的比值较术前均明显改善(P<0.01);末次随访时与术后1周时比较无显著性差异(P>0.05)。术前脊髓神经功能受损的5例患者术后均恢复到E级。结论:采用后路切开复位减压单节段椎弓根螺钉内固定结合经椎间孔椎体间植骨融合治疗胸腰椎单椎体A3型爆裂骨折手术时间短、出血少,复位固定可靠,融合节段少,是治疗胸腰椎单椎体A3型爆裂骨折的有效方法之一。

Objective：To assess the efficacy and feasibility of posterior monosegmental pedicle screw fixation combined with transforaminal lumbar interbody fusion（TLIF）for traumatic Type A3 thoracolumbar burst fracture.Method：16 patients with isolated type A3（according to the AO classification）thoracolumbar burst fracture undergoing posterior monosegmental pedicle screw fixation and TLIF between March 2005 and October 2007 were reviewed retrospectively.The involved levels included T11（2）,T12（2）,L1（5）,L2（5）,L3（1）and L4（1）.Five patients had incomplete neurological deficit including 1 grade C,4 grade D evaluated by Frankel grading system.The anterior vertebral body height and segmental Cobb angle of pre-and post-operative immediate and final follow-up were assessed under radiographs.Result：All operations were completed successfully,no instrument failure and neurovascular complication were noted.The mean operation time was 125min（range,90-180min）,the mean blood loss was 330ml（range,200-600ml）,all patients were followed-up for 1038 months（mean,14.6 months）.All patients had solid bony fusion at final follow-up.The post-operative radiographs demonstrated good reduction without loss until the bony fusion.Neurological improvement was noted in all five patients with partial neurological deficit.Conclusion：Posterior monosegmental pedicle fixation combined with TLIF is feasible and reliable for isolated type A3 thoracolumbar burst fractures,which provides time efficient,less blood loss and short segment fusion.