CYL脊柱内固定器治疗胸腰段爆裂骨折疗效评价

Successful short-segment fixation for thoracolumbar burst fractures using CYL-pedicle screw

目的评价CYL脊柱内固定器后路短节段内固定治疗无神经损伤的单节段胸腰段爆裂骨折疗效。方法回顾分析2007年9月至2009年12月74例无神经损伤的单节段胸腰段爆裂骨折（Denis爆裂骨折A、B、C型）患者资料，男性53例，女性21例，年龄（18～64）岁，平均（394-15）岁。所有患者均行后路短节段内固定，未直接减压，亦未植骨融合。比较术前、术后、拔钉前及末次随访椎体前高压缩率、椎体楔形角、Cobb角、局部后凸角、腰椎疼痛及功能评分变化情况；记录切口感染、断钉、医源性脊髓损伤发生情况。结果随访14～38个月，平均（20±11）个月。Cobb角矫正丢失明显，为9．8°±5．1°，局部后凸角矫正丢失为9．1°±4．8°，差异均具有统计学意义（t=2．48和3．41，P〈0．05）；椎体前高压缩率、椎体楔形角变化差异无统计学意义（P〉0．05）。术前Cobb角≤20°与术前Cobb角〉20°的患者比较，末次随访时疼痛较轻（优良率98．3％比86．7％，x^2=4．16，P=0．04），功能更佳（优良率88．1％比66．7％，x^2=24．34，P〈0．01）。手术切口感染1例，断钉1例，螺钉松动1例，无医源性脊髓损伤病例。结论CYL脊柱内固定器后路短节段固定治疗无神经损伤的单节段胸腰段爆裂骨折，影像及临床结果满意，可作为一种安全可靠的治疗选择。

Objective To access the efficacy of posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury using CYL-pedicle screw. Methods From September 2007 to December 2009, 74 cases who underwent posterior short-segment fixation for single level thoraeolumbar burst fractures （Denis burst fracture type A, B, C ） without spinal injury were analyzed retrospectively. There were 53 male and 21 female, mean age was （39 ± 15 ）years. Neither of them treated with direct decompression, grafting or fusion. Changes in the anterior vertebral height ratio, vertebral wedge angle, Cobb angle, regional angle were measured preoperatively, postoperatively, before implant removal, and at final follow-up to find the statistic difference. Pain status and work status were evaluated using Denis criterion. The incidence of incision infection, screw breakage, iatrogenic spinal injury were recorded as well. Results The time of follow-up was （20 ± 11 ） months, no significant change was noted in anterior vertebral height ratio and vertebral wedge angle （ P 〉 0. 05 ）. A significant loss was noted in Cobb angle and regional angle, which were 9. 8 ° ±5.1° and 9. 1 °± 4. 8° respectively （ t = 2. 48 and 3.41, P 〈 0. 05 ）. Comparing with the patients with Cobb angle 〉 20°, the patients with Cobb angle ≤20°had better pain scale rate （X2 = 4. 16, P =0. 04） and work scale rate （ X2 = 24. 34, P 〈 0. 01 ） . There were incision infection in 1 case, screw breakage in 1, screw loose in 1, and no iatrogenic spinal injury. Conclusions CYL-pedicle screw could be successfully used in posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury based on radiographic and clinic outcomes.