后路减压椎弓根钉内固定治疗胸腰椎骨折伴不全瘫

Study the Effect of Posterior Fixation with Pedicle Screw System for Thoracic and Lumbar Vertebrae Burst Fracture with Incomplete Neurological Deficit

目的探讨经后路减压椎弓根钉内固定手术治疗胸腰椎骨折合并不全瘫的术后神经功能恢复效果。方法回顾性分析2005年1月到2006年1月收治的胸腰椎骨折脱位合并不全瘫病例共30例,其中男性21例,女性9例。神经损伤按照ASIA分级,B级10例,C级12例,D级8例。所有病例均采用后路椎弓根钉短节段固定减压手术。结果所有病例均得到有效随访,平均28.3个月,脊柱后凸角度(Cobb′s角)由术前的(24.3±4.6)°平均恢复到(3.6±1.2)°;伤椎椎体前缘高度恢复率由术前(35.8±5.3)%平均恢复到(90.2±3.8)%;椎管占有率由手术前平均(58.3±10.7)%恢复至术后平均(8.4±1.7)%。神经功能ASIA分级术后随访部分有明显改善。Dennis工作评分:11例患者可以再次获得稳定工作。结论后路减压椎弓根内固定手术治疗胸腰段骨折固定确实,且手术后对于神经恢复有良好改善,能使部分患者恢复工作。

Objective To explore the therapeutic effect of neurological function recovery with surgical treatment on thoracic and lumbar vertebrae burst fracture-dislocation with incomplete neurological deficit by posterior approach.Methods The clinical date of 30 cases of the thoracic and lumbar vertebrae burst fracture-dislocation with incomplete neurological deficit were analysed retrospectively.male 21 cases female 9 cases.According to ASIA grading：B 10 cases;C 12 cases;D 8 cases.All of the patients were treated by posterior fixation with pedicle screw system and decompression.Results All the patients were followed up for mean 28.3months effectively.The mean kyphotic angle was improved from（24.3±4.6）° degrees preoperatively to（3.6±1.2）°degrees postoperatively,The average recovery rate of pre-operative anterior vertebral body height was（35.8±5.3）%,which improved to（90.2±3.8）% in the immediate post-operative period.and the mean rate of canal compromise was improved from（58.3±10.7）% preoperatively to（8.4±1.7）% postoperatively,According to ASIA grading,part of the cases were improved.As for the Dennis work scale：11 cases work full time at new job.Conclusion Posterior fixation with pedicle screw system and decompression can stabilize the thoracic and lumbar vertebrae burst fracture,improve the neurological function and help some pacients to work again.