连续椎弓根螺钉技术在治疗胸腰椎骨折中的应用

Continuous pedicle screw fixation in the treatment of thoracolumbar fractures

目的探讨经骨折椎连续椎弓根螺钉内固定术治疗胸腰椎骨折的可行性、适应证和临床疗效。方法对62例胸腰椎骨折患者采用单侧或双侧的经骨折椎连续椎弓根螺钉内固定术,分别测量术前、术后和随访时椎体高度、脊柱Cobb's角,椎管内占位百分比,以ASIA2000分级标准评定神经功能,以Charles标准评定临床疗效。结果随访12～36个月,平均18个月,无断钉断棒及内固定松动发生,骨折椎椎体前缘高度值由术前的31.2%±3.0%恢复至91.7%±2.0%,脊柱Cobb's角由术前的30.5°±4.0°矫正至7.1°±1.0°,椎管占位率由术前的75%(30%～95%)减少到3%(0～8%),神经功能ASIA分级提高1～3级,临床疗效按Charles标准优良率为88.7%。结论在适应证范围内采用连续椎弓根螺钉内固定术治疗胸腰椎骨折可弥补传统跨节段椎弓根螺钉内固定术的不足而非替代,在提高复位效果、维持有效生理弧度、减少内固定失效等方面具有一定优势。

Objective To explore the feasibility and efficacy of continuous pedicle screw fixation in the treatment of thoracolumbar fractures,and to consider its indications.Methods Sixty-two patients with thoracolumbar fractures were treated with the injuried vertebra transpedicular unilateral or hibateral fixation.Before and after surgery and at follow-up, these patients were evaluated with X-ray for anterior heights of the injured vertebra（AHIV ） and Cobb＇s angle,and with CT scans for sagittal canal diameter（SCD）.ASIA 2000 classification standard was used to investigate neurological function. And Charles＇ standard was applied to evaluate the clinical outcomes.Results All the patients were followed up for 12-36 months（average 18 months）.All the fractures were reduced and the internal fixation did not loose and break.And there were no lose of correction and other complications.AHIV showed good recovery[（91.7±2.0）%vs（31.2±3.0%）%,preoperatively].Cobb＇s angle appeared smaller[（7.1±1.0）°vs（30.5±4.0）°,preoperatively（in degrees）]. Sagittal canal diameter was reduced[0-8%（mean 3%） vs 30%- 95%（mean 75%）,preoperatively]. Neural functions showed 1 to 3 grades improvement compared with the findings before operation.Conclusion It is a feasible and effective method to treat thoracolumbar fractures by continuous pedicle screw system with screw placed at the level of the fractured vertebra according to the indications range.It can redeem the shortage of traditionally methods,improve repositioning effect and maintain effective physiological radian.Meanwhile,it can reduce internal fixation failure.