个体优化经椎弓根置钉复位内固定治疗胸腰椎骨折

Individual optimized pedicle screw reset and fixation treatment for thoracolumbar fractures

背景：在日臻成熟的椎弓根螺钉应用技术中,仅满足于将螺钉置入椎弓根中是不够的,而是应根据骨折复位固定要求寻求最佳置钉通道。目的：验证经椎弓根内固定个体化治疗胸腰椎骨折的有效性和安全性。方法：对50例胸腰椎骨折患者内固定前X射线片和CT片进行个体化矢状面及水平面椎弓根螺钉置入角、椎弓根横径、间距、钉道深度、椎体前后高、脊柱后凸角及椎管前后径测量,确定胸腰段椎弓根钉道个体优化置钉和复位的安全范围。术中结合解剖定位标志,C臂X射线机监控置钉并复位骨折椎体,确定复位结果。结果与结论：置钉位置良好,角度及深度适中,内固定后骨折椎体复位高度、后凸角及椎管面积改善（P〈0.01）。经2~26个月随访,骨折均愈合。提示在胸腰段椎弓根钉道个体化影像测量安全范围内,优化置入椎弓根钉和复位是保证置钉内固定安全和椎体骨折复位合理而有效的方法。

BACKGROUND：With the development of pedicle screw technology,it is not enough only to pedicle screw implantation.It should choose the best channel for pedicle screw implantation based on fracture reduction and fixation.OBJECTIVE：To improve the treatment safety and effectiveness of individual pedicle screw fixation for thoracolumbar fractures.METHODS：Preoperative X-ray and CT were performed in 50 cases of thoracolumbar fractures to measure the pedicle width,the screw path length,the distances between pedicles,the transverse and sagittal screw angle,the compress of the vertebrace,the spinal Cobb＇s angle.The individual optimized range to safely implant pedicle screws was selected.Combined with anatomical localization,C-arm X-ray was used to guide operation orientation and inspect outcome.RESULTS AND CONCLUSION：The position of the screw was good,the angle was correct,and the length was suitable.The compress of the vertebrace and the spinal Cobb＇s angle were improved significantly after operation（P 0.01）.Fifty cases were followed up for 2 to 26 months,with an average of 12 months,and the fractures healed.Individual radiology measurement combined with anatomical localization is a reasonable and effective method,which is helpful to evaluate the security and the efficiency of transpedicle internal fixation.