一期后路SSPI并椎间/椎体植骨治疗胸腰椎爆裂型骨折

Treatment of thoracolumbar burst fractures by SSPI combined with interbody/centrum bone graft

目的评价一期后路经椎弓根短节段内固定(SSPI)并椎间/椎体植骨治疗胸腰椎爆裂型骨折的临床疗效。方法回顾性分析了2007年3月～2009年10月在该院住院治疗的32例胸腰椎爆裂型骨折患者的临床资料,采用一期后路SSPI并椎间/椎体植骨的手术方式进行治疗,对患者手术前后骨折椎椎体前缘高度、椎管狭窄指数、cobb角度数、胸腰背功能及脊髓神经功能的改善等情况进行比较,观察并评估其临床疗效及骨性融合情况。结果术后所有患者均获得了随访,随访时间为6～18个月,平均14个月,损伤节段骨性融合率为100%。其中,骨折椎椎体前缘高度从术前的(13.8±4.2)mm恢复至术后末次随访时的(26.4±5.6)mm;后凸角从术前的(23.4±7.2)°恢复至术后末次随访时的(5.5±2.9)°;cobb角度数从术前的(21.3±6.4)°恢复至术后末次随访时的(5.3±2.7)°;椎管狭窄指数全部恢复为0;胸腰背功能(Oswestry功能障碍指数)及神经功能(Frankel脊髓损伤分级)情况均较术前有明显改善,经比较差异有显著性(P<0.05)。结论一期后路SSPI并椎间/椎体植骨治疗胸腰椎爆裂型骨折,具有操作简单,创伤小,术后并发症少,骨性融合良等特点,是治疗胸腰椎爆裂型骨折的一种有效手术方式。特别是对于不完全性脊髓损伤,更具良好的临床疗效。

[ Objective ] To assess the clinical effects of thoracolumbar burst fractures through one-stage posterior short segmentpedicle instrumentation combined with interbody/centrum bone graft. [Methods ] The clinical data of the 32 cases were retrospectively analyzed from March 2007 to October 2009 in the spine surgery department of Xiangya hospital. These eases were treated by the operation of the one-stage posterior short segmentpcdicle instrumentation combined with interbody/centrum bone graft. The clinical effects and bony fusion level were valuated by the comparison and analysis of the aspects involved the fracture vertebral anterior height, canalis spinalis stenosis index, cobb angle, improvement of the function of the thoracolumbar and spinal cord and nerve before and after operation. [Results] All cases were followed up, and the follow-up time varied from 6 months to 8 months ,mean 14 months. The bony fusion rate of the fusion section was 100%, and that the statuses of the fracture vertebral anterior height, kyphofic angle, cobb angle, canalis spinalis volume index, Oswestry disability index and Frankel grades were improved significantly compared with those preoperative （P 〈0.05）, and the first three items were improved from preoperative （13.8±4.2）mm, （23.4±7.2）°, （21.3±6.4）° to postoperative （26.4±5.6） mm, （5.5±2.9）°, （5.3±2.7）° separately. Meanwhile the canalis spinalis stenosis indexes of the fracture centrums were all 0 score. [ Conclusion ] One-stage posterior short segment pedicle instrumentation combined with interbody/centrum bone graft is one of the effective operation ways for the treatment of thoracolumbar burst fractures, with many traits such as simplicity of operation, micro-trauma, less postoperative complication and good osseous fusion. Especially for the treatment of incomplete spine cord injury, it provides more excellent clinical effects.