后路短节段固定联合经伤椎椎弓根螺钉固定及椎体内人工骨植骨治疗胸腰椎爆裂性骨折

Treatment of thoracolumbar burst fractures with posterior short-segment fixation combined with unilateral transpedicular screw fixation and bone grafting in fracture vertebral body through pedicle passage on opposite side

目的探讨后路短节段椎弓根螺钉固定联合经伤椎一侧椎弓根内固定,另一侧椎体内人工骨植骨治疗胸腰椎爆裂性骨折的临床疗效。方法收集我院2006年1月至2008年12月收治单节段受累胸腰椎爆裂性骨折患者28例,其中男22例,女6例,累及T114例,T1210例,L110例,L24例,均采用短节段经伤椎上下位椎体椎弓根螺钉固定,经伤椎一侧椎弓根螺钉固定,另侧椎体内硫酸钙人工骨植骨术治疗。术后6个月、12个月及24个月行正侧位X线复查,通过比较术前、术后伤椎与上位椎体前缘高度比值、伤椎楔变角、神经功能恢复情况(美国脊髓损伤协会分级标准),评价其临床疗效。结果术后除5例患者出现脑脊液漏外,其余均未出现伤口相关并发症。术后6个月、12个月及24个月后伤椎楔变角、伤椎与上位椎体前缘高度比值均明显改善(P均<0.05),术后12个月及24个月,伤椎楔变角、伤椎与上位椎体前缘高度比值较术后6个月变化不明显(P均>0.05)。神经功能除2例A级无变化外,其余均较术前有1～2级恢复。结论采用后路短节段固定联合经伤椎一侧椎弓根螺钉固定,另一侧经椎弓根通道椎体内人工骨植骨治疗胸腰椎爆裂性骨折,有利于伤椎的复位及增强前柱的稳定性,维持术后椎体高度及防治矫正角度的丢失,防止取骨区相关并发症的发生。

Objective To assess the curative effect of posterior short-segment fixation combined with unilateral transpedicular screw fixation and bone grafting in the fracture vertebral body through pedicle passage on the opposite side in the treatment of thoracolumbar burst fractures. Methods Twenty-eight （22 males and 6 females） cases with a single-level thoracolumbar burst fracture from January 2006 to December 2008 were enrolled in the study. The fractures occurred at the thoracolumbar junction from T11 to L2 with the cases of 4, 10, 10, 4, respectively. The patients all received short-segment fixation for the adjacent segments combined with unilateral transpedicular screw fixation and intracorporeal calcium sulfate bone grafting in the fracture vertebral body through pedicle passage on the opposite side. All the patients were followed clinically and radiologically by X-ray and computed tomographic scan 6, 12, 24 months after the operation. The ratio of anterior vertebral height （AVH） between injured level and upper level, vertebral wedge angle （VWA） and improvement of the neurologic functions （based on American spinal injury association assessment grade） were recorded and analyzed. Results Cerebrospinal fluid leakage were found in 5 cases and in the rest 23 cases no wound infection were revealed. Compared to the preoperative status, our follow-up examinations demonstrated that the VWA and the ratios of AVH between injured level and upper level were all improved 6, 12, 24 months after the operation （all P〈0.05）, while the improvements showed slightly differences among the 6, 12, and 24 months （all P〉0.05）. No neurological deterioration was seen, and in 26 cases a one grade or better improvement was observed. Conclusion Posterior short-segment fixation combined with unilateral transpedicular screw fixation and intracorporeal grafting on the opposite side of fracture vertebral body for thoracolumbar burst fractures can achieve favorable effect on repositioning the injured vertebral body, stabilizing the frontal column of the spine, maintaining the vertebral body height and angle and preventing the complications from the bone grafting area.