椎弓根内固定术治疗胸腰椎骨折32例分析

Analysis of Efficacy of Internal Fixation Using Pedicle Screw Systems for Thoracolumbar Burst Fractures

目的探讨短节段椎弓根内固定结合后外侧植骨(posterolateral fusion,PLF)治疗胸腰椎骨折的疗效价值。方法胸腰椎骨折患者32例,受伤原因:车祸伤11例,坠落伤10例,重物砸伤6例,其他5例。按照Denis分型:单纯压缩骨折11例,爆裂骨折21例。骨折共累及椎体32椎,T102椎,T113椎,T128椎,L110椎,L25椎,L34椎。均行短节段椎弓根内固定结合后外侧植骨治疗。评价内容包括手术时间、失血量、住院时间。结果手术时间平均92min,平均失血量420ml,供骨区并发症发生率25%。所有患者术后均获12～24个月随访,平均18个月。术后3月内固定椎弓根钉断裂1例,供骨区疼痛或不适8例,发生率25%。结论胸腰椎骨折短节段椎弓根内固定结合后外侧植骨的短期疗效满意。

Objective To analyze the therapeutic efficacy of short segment pedicle instrumentation combined with posterolateral bone grafting and fusion（PLF） on the surgical treatment of thoracolumbar burst fractures. Methods Thirty-two patients with tho- racolumbar burst fractures were enrolled in this study, the causes of 11 cases were road accident, 10 cases were falling injury,6 cases were heavy object breaking,5 cases were other causes. According tO Denis classification, 11 cases were simple compression bone fracture ,21 cases of rupture the bone fracture. Total 32 centrums were involved in the bone fracture：two T10, three T11 , eight T12 ,ten Ll ,five L2 and four L3. All patients underwent short segment pedicle instrumentation combined with PLF. The operative time, blood loss and hospital time were evaluated. Results The average operative time was 92 minutes, the average volume of blood loss was 420 ml, and the rate of complications in the donor site was 25%. All patients were follow-up for 12 to 24 months （ average 18 months）. One case was with internal pedicle screw breaking 3 months late. 8 cases were with the pain or discomfort of donor area（25% ）. Conclusion The short-term curative efficacy of short segment pedicle instrumentation＇combined with PLF was satisfactory in the surgical treatment of thoracolumbar burst fractures.