钉棒系统复位联合经椎弓根椎体植骨治疗胸腰椎骨折

AF system fixation and transpedicular bone graft in treatment of thoracolumbar fractures

目的探讨AF系统复位内固定结合经椎弓根椎体内植骨治疗胸腰椎前中柱骨折的疗效。方法采用AF复位内固定,经椎弓根椎体植骨治疗胸腰椎骨折35例,术前、术后和随访期间均摄X线片,检测椎体高度丢失情况以及成角段Cobb角度变化,观察骨折愈合情况。对比治疗前后ASIA分级。结果 31例获5-36个月的随访。Cobb角术前为23.5°±6.8°,术后为2.6°±6.2°,差异有统计学意义（P〈0.05）。椎体前后缘高度比值术前为0.5±0.2,术后为0.9±0.1,差异有统计学意义（P〈0.05）。术后3个月骨折椎体愈合,伤椎高度无丢失。术后ASIA分级：A级5例中3例无改善,2例恢复至C级;4例B级中2例恢复至C级,2例恢复至D级;C级5例中2例恢复至D级,3例恢复至E级;D级5例均恢复至E级;E级16例仍为E级。结论使用AF复位内固定治疗胸腰椎骨折,操作简单、快捷,伤椎体回复高度满意,联合经椎弓根椎体内植骨,重建前中柱的稳定性好。

Objective To evaluate the role and the effect of AF system fixation and transpedicular bone graft for the treatment of thoracolumbar fractures of anterior and medial columns.Methods Thirty-five cases of thoracolumbar fractures of anterior and medial columns were treated by AF system and transpedicular bone graft.Pre and post-operation X-ray films were taken,Cobb′s angles of injured segment and ratio of the height of anterior to posterior side of the vertebrae were measured,and ASIA scales were recorded.Results 31 cases were followed up for 5~36 months.The Cobb′s angle were 23.5°±6.8°（preoperation） and 2.6°±6.2°（postoperation）,and the ratio of the height of anterior to posterior side of the vertebral body were 0.5±0.2（preoperation） and 0.9±0.1（postoperation）,there were significant difference（P0.05）.There was no reduction of the height of the vertebral body in 3 months.Among 5 cases of ASIA A,2 recovered to C,3 got no recovery;Among 4 cases of B,2 recovered to C,2 recovered to D;Among 5 cases of C,2 recovered to D,3 recovered to E;All of 5 cases of D recovered to E,and 16 cases of E were maintained E.Conclusions AF system fixation can be simply manipulated.The AF system can recover the height of the injured vertebrae,and when associate with transpedicular intracorporeal grafting,it is more effective for treating thoracolumbar fractures of anterior and medial columns.