CD2椎弓根螺钉置入内固定治疗胸腰椎爆裂性骨折(英文)

CD2 pedicle-screw internal fixation for treatment of thoracolumbar burst fractures

背景:随着椎弓根钉的发展,经椎弓根内固定系统能够提供坚强内固定使损伤脊柱获得多平面稳定,同时具有创伤小、操作简便等优点,现已大量应用于胸腰椎骨折治疗当中。目的:观察CD2椎弓根螺钉置入内固定治疗胸腰椎爆裂性骨折的远期疗效。方法:回顾性分析2000-01/2008-01南通市中医院骨伤科收治的胸腰椎爆裂骨折患者72例,均采用CD2椎弓根螺钉置入内固定治疗,于治疗前后、末次随访时拍摄腰椎正侧位X射线平片,观察置入后与随访时椎体前后缘的平均高度、植骨融合情况、脊柱后凸cobb角的变化;其中27例置入前、末次随访均行CT检查,评价椎管内占位情况;Frankel分级评价神经系统的恢复;腰痛末次随访按Oswestry功能障碍指数问卷表评分。结果与结论:72例患者均获得随访,随访时间0.5～8年,平均48个月。X射线观察置入后椎体的前、后缘高度及cobb角复位分别为6.55,2.69mm、25.7°,随访时矫正的丢失为2.29,1.74mm、2.6°。CT随访的27例中原椎管占位率为10%～75%,末次随访时为5%～24%。在末次随访中20例存在蛋壳现象。有神经部分损伤的患者按Frankel分级均有1级以上的恢复,完全性脊髓损伤者有部分恢复。Oswestry评分结果:0%23例,2%29例,3%5例,6%5例,8%4例,10%1例,56%1例,57%1例,80%1例,87%2例。全部患者中发生钉棒松动1例,棒断裂1例,螺钉松动2例,螺钉断裂1例。提示CD2椎弓根螺钉内固定治疗胸腰椎爆裂性骨折能够很好地恢复椎体的高度、生理弧度及神经功能。

BACKGROUND：With the development of pedicle-screws,pedicle-screw internal fixation system has been widely used in the clinical treatment of thoracolumbar fractures because it can provide rigid internal fixation for injured spine to acquire more dimensional stabilization with little trauma and simple operation. OBJECTIVE：To investigate the long-term therapeutic effects of CD2 pedicle-screw internal fixation in treatment of thoracolumbar burst fractures. METHODS：A retrospective analysis was made on 72 cases of thoracolumbar burst fractures who received treatment at the Department of Orthopedics and Traumatology of Nantong University of Traditional Chinese Medicine between January 2000 and January 2008. All these patients received CD2 pedicle-screw internal fixation treatment. All of them were checked with radiography prior to and after surgery and at the final follow-up. The anterior and posterior vertebral body height,the situation of bone graft fusion,and the change of cobb angle were observed after surgery and at final follow-up. CT examination was performed in 27 cases prior to surgery and at the final follow-up to evaluate the space occupying in the spinal canal. Frankel classification was performed to evaluate the recovery of nerve system and Oswestry Disability Questionnaire was used to score the back pain at the final follow-up. RESULTS AND CONCLUSION：72 cases were followed up for an average of 48 months （range 0.5-8 years） after surgery. X-ray results showed that after surgery,the correction of anterior vertebral body height averaged 6.55 mm,posterior vertebral body height 2.69 mm,and cobb angle 25.7°,and at the final follow-up,correction loss averaged 2.29 mm in the anterior vertebral body height,1.74 mm in the posterior vertebral body height,and 2.6° in the cobb angle. Among 27 patients scanned by CT,the space-occupying rate of the vertebral canal was 10%-75% prior to surgery and it was declined to 5%-24% at the final follow-up. In the last survery,eggshell phenomenon was still observed in 20 cases. Neurological status improved at least 1 Frankel grade in the patients who had preoperative incomplete paraplegia,while no improvement was obtained in those who had preoperative complete paraplegia. Clinical curative effects were evaluated according to Oswestry Disability Questionnaire,results showed 0% in 23 cases,2% in 29 cases,3% in 5 cases,6% in 5 cases,8% in 4 cases,10% in 1 case,56% in 1 case,57% in 1 case,80% in 1 case,and 87% in 2 cases. Nuts loosened in 2 cases,pedicle screws loosened in 2 cases,and sticks broken in 1 case. All these findings indicate that CD2 pedicle-screw internal fixation in treatment of thoracolumbar burst fractures can well restore vertebral heights,physiologic curves,and neurological functions.