胸腰段骨折病理特点及治疗

Clinical feature and treatment of thoracolumbar fracture

目的探讨胸腰段骨折的病理特点及椎弓根螺钉内固定系统在其治疗中的应用及临床效果。方法 2005年3月～2010年3月,共94例胸腰段骨折患者行根螺钉内固定治疗,其中行跨伤椎椎弓根螺钉内固定术76例,行经伤椎椎弓根螺钉内固定术18例。通过观察伤椎椎体高度、伤椎后凸Cobb角、疼痛视觉模拟量表(visual analoguescale,VAS)评分、美国脊髓损伤学会(American Spinal Injury Association,ASIA)评分及术后X线片对患者的恢复情况进行评价。结果所有患者术后随访6～24个月,平均15个月。患者椎体高度恢复率为89%～100%,平均为94%;Cobb角恢复到0°～6°,平均2.3°;VAS评分恢复至0～3分,平均1.3分;神经功能明显恢复,与术前相比差异有统计学意义(P<0.05)。结论椎弓根螺钉内固定系统是治疗胸腰段骨折的有效方法,其中短节段经伤椎椎弓根内固定可能成为一种更具优势的内固定方式。

Objective To explore the clinical feature of thoracolumbar fracture and the clinical outcomes of pedicle screw fixation for the patients with thoracolumbar fracture.Methods From March 2005 to March 2010,94 patients with thoracolumbar fracture were treated by pedicle screw fixation.There were 76 patients with classic short-segment fixation and 18 patients with short-segment fixation at the injured level.Preoperative and postoperative height and of injured vertebral body,Cobb＇s angle,visual analogue scale（VAS） and American Spinal Injury Association（ASIA） scores were recorded to evaluate the therapeutic effects.Results All the patients were followed up for 6-24 months（mean 15 months）.The recovery rate of injured vertebral height was 89%-100%（mean 94%）.Postoperative Cobb＇s angle was 0°-6°（mean 2.3°） and VAS score was 0-3（mean 1.3）.There was significant difference of neurological function before and after treatment（P0.05）.Conclusion Pedicle screw fixation system is an effective treatment for thoracolumbar fracture.The short-segment screw fixation at injured levels may become a more competitive internal fixation.