后路椎弓根螺钉内固定治疗多节段胸腰椎骨折

Posterior pedicle screws fixation for multiple-level thoracolumbar fractures

目的探讨后路椎弓根螺钉内固定系统治疗多节段胸腰椎骨折(MSF)的临床疗效。方法对27例MSF患者在伤后2～11 d行后路椎弓根螺钉系统内固定手术治疗。测量术前与末次随访时椎体高度与后凸角,对神经功能进行Frankel评分,评价疗效。结果患者均获随访,时间7～36(25±4)个月,伤椎前缘高度术前为30%～70%(48.3±7.8)%,末次随访时为80%～100%(93.1±4.0)%,差异有统计学意义(P<0.01);后凸角术前为20～35(28.3±5.8),°末次随访时为5～15(7.3±2.8)°,差异有统计学意义(P<0.01)。内固定无松动、断裂。Frankel分级:A级3例无恢复;B级4例恢复至C级3例、D级1例;C级4例均恢复至D级;D级9例5例恢复至E级,4例无恢复。结论椎弓根螺钉内固定系统治疗MSF能有效复位骨折椎体,重建脊柱稳定性,临床疗效满意。

Objective To explore the clinical efficacy of posterior pediele screw internal fixation in the treatment of muhiple-level thoraeolumbar fractures. Methods 27 patients with the multiple-level thoracolumbar fracture were treated by posterior pedicle screw internal fixation in 2 - 11 days after injury. The Frankel score, vertebral body height and angle of kyphosis defomlity were analyzed to evaluate the surgery efficacy. Results All cases were followed up for 7 ~ 36 （25 ± 4 ）months. The anterior vertebral body height of fracture vertebra was restored from preoperative 30% 70% （48. 3 ± 7. 8 ） % to 80% - 100% （ 93. 1± 4. 0 ） % （ P 〈 0. O1 ）. The kyphosis deformity angle was eotTected from pre - operation 20 - 35 （ 28.3 ± 5.8 ） o to follow-up 5 - 15 （ 7.3 ± 2.8 ） o （ p 〈 0. 01 ）. No loosening or breakage of the pediele screws ocurred. 3 cases with Frankel grade A before operation remained Frankel grade A. 4 cases with Frankel grade B improved to Frankel grade C in 3 cases and 1 case to Frankel grade D. 4 cases with Frankel grade C improved to Frankel grade D. 9 cases with Frankel grade D improved to Frankel grade E in 5 cases,4 cases of which got no improvement. Conclusions The pedicle screw instrumentation system can rebuild spinal stability and restore spinal alignment in the treatment of multiple-level thoracolumbar fractures.