后路伤椎上间隙融合双节段固定治疗DenisB型椎体爆裂性骨折

Treatment of thoracolumbar burst fractures of Denis type B by posterior bisegmental stabilization plus monosegmental fusion

目的探讨后路伤椎上间隙融合双节段固定治疗DenisB型椎体爆裂性骨折的临床疗效。方法2009年7月至2011年1月收治8例DenisB型椎体爆裂性骨折患者，男5例，女3例；年龄20～68岁，平均42岁。采用后路伤椎上间隙融合双节段固定，比较术前、术后Frankel分级变化、术前、术后及末次随访时伤椎前缘高度比值、后缘高度比值、Cobb角及椎管容积变化，评价临床疗效。结果8例患者术后获7～18个月（平均13．1个月）随访。患者骨折脱位均获复位，无血管、神经损伤及内固定松动等并发症发生，脊髓功能均有不同程度的恢复，术后椎体前缘高度比为0．97±0．02、椎体后缘高度比为0．97±0．03，Cobb角为-0．25°±1．82°、椎管容积率为93．40％±5．30％，与术前比较差异有统计学意义（P〈0．05）。末次随访椎体前缘高度比为0．97±0．03，椎体后缘高度比为0．98±0．02、Cobb角为-0．13°±1．88°，与术后相关指标比较差异均无统计学意义（P〉0．05）。结论后路伤椎上间隙融合双节段固定治疗DenisB型椎体爆裂性骨折可以有效地恢复脊柱生理曲度，充分减压椎管，重建脊柱稳定性，同时保留了未损伤的伤椎下位椎间盘，具有良好的应用前景。

Objective To investigate the efficacy of posterior bisegmental stabilization plus monosegmental fusion in the treatment of thoracolumbar burst fractures of Denis type B. Methods From July 2009 to January 2011, 8 patients with vertebral body burst fracture of Denis type B were treated with posterior bisegmental stabilization plus monosegmental fusion. The upper interspace of the injured vertebra was fused posteriorly. They were 5 men and 3 women, aged from 20 to 68 years （average, 42 years）. The neurological status was evaluated by Frank grading system. The ratio of the anterior margin height of the injured vertebral body to the normal height （RAH）, the ratio of the posterior margin height of the injured vertebral body to the normal height （RPH）, the Cobb angle and the volume ratio of spinal canal were compared respectively between preoperation and postoperation to evaluate the clinical efficacy. Results The 8 patients were followed up for 7 to 18 months （average, 13.1 months）. Fracture dislocation was completely reset. No vascular or nerve damage, or other complications, such as loosening of internal fixation, was found. All patients had neuro-functional improvement by at least one Frank grade. The postoperative RAH （0.97± 0.02）, RPH （0. 97 ± 0.03）, Cobb angle （ - 0. 25° ± 1.82°）, and the spinal canal volume ratio （93.40 ± 5.30） were improved significantly compared with the preoperative data （ P 〈 0.05）, but had no significant differences compared with the last follow-up data （ P 〉 0. 05） . Conclusion In treatment of thoraeolumbar burst fractures of Denis B-type, posterior bisegmental stabilization plus monosegmental fusion can effectively restore the spinal curvature, decompress the spinal canal, reconstruct spinal stability, and preserve the intact disc under the injured vertebra.