后路椎弓根螺钉内固定治疗相邻两节段胸腰椎骨折

Posterior pedicle screw fixation for adjacent two-segment thoracic and lumbar vertebral fractures

目的探讨后路三种不同内固定方法治疗相邻两节段胸腰椎骨折的临床疗效。方法回顾性分析2003-2010年收治的相邻两节段胸腰椎骨折34例患者资料，分别采用经后路4椎4钉（Ⅰ组）、4椎6钉（Ⅱ组）和4椎8钉（Ⅲ组）三种不同的椎弓根螺钉内固定方法进行治疗。分析术前、术后及末次随访时脊柱Cobb角的变化，并进行Oswestry功能障碍指数（Oswestrydisabil-ityindex，ODI）评分、Denis疼痛和Denis工作评级，观察神经功能恢复情况。结果患者获得随访10-48个月，平均24个月。所有患者神经功能均有不同程度的恢复。Ⅰ组有2例椎弓根螺钉断裂，1例伤椎塌陷自发融合。三组术后Cobb角均减小，而在末次随访时均有一定程度的增加。Ⅰ组术后Cobb角为（7．5±3．0）°，末次随访（13．7±5．1）°，矫正丢失（6．2±2．1）°；Ⅱ组术后Cobb角为（1．4±1．5）°，末次随访（4．5±2．4）°，矫正丢失（3．1±1．1）°；Ⅲ组术后Cobb角为（0．0±1．1）°，末次随访（1．34±1．2）°，矫正丢失（1．3±0．1）°。三组间矫正丢失比较，差异有统计学意义（P〈0．05）。末次随访时，在ODI、Denis疼痛和Denis工作评级上Ⅱ组与Ⅲ组差异无统计学意义，但与I组比较差异均有统计学意义（P〈0．05）。结论后路经伤椎置钉的4椎8钉法连续椎弓根内固定治疗相邻两椎体胸腰椎骨折具有良好的复位、固定、维持畸形矫正、保留运动节段及缓解术后疼痛的临床疗效，该技术方法简单、易行，值得临床推广。

Objective To investigate the clinical outcomes of three kinds of internal fixations via posterior approach for treating adjacent two-segment thoracic and lumbar vertebral fractures. Methods A retrospective analysis was done on data of 34 patients with adjacent two-segment thoracic and lumbar vertebral fractures treated between 2003 and 2010. The treatments included three different pedicle screw fixations via posterior approach, ie, fixation with four vertebrae and four screws （ GroupⅠ , n = 14 ） , fix- ation with four vertebrae and six screws （ Group Ⅱ, n = 11 ） , fixation with four vertebrae and eight screws （ GroupⅢ, n = 9）. The changes of spinal Cobb＇ s angle before and after operation and at the last final follow-up were statistically analyzed. Oswestry disability index （ODI） score, Denis pain scale and Denis work scale at the final follow-up were evaluated. Also, the recovery of neurological function was observed. Results The duration of follow-up was average 24 months （range, 10-48 months）. The neurological function of all the patients recovered to some degree. Two patients had pedicle screw breakage and one had spontaneous fusion of the collapsed vertebra in Group Ⅰ. The Cobb＇ s angles of the three groups were decreased immediately after operation, but all obtained some degree of enhancement at the final follow-up. In Group Ⅰ, the mean Cobb＇ s angle was （7.5 ±3.0） ° postoperatively and then improved to （ 13.7 ±5.1 ） ° at the final follow-up, with correction loss of （6.2 ± 2.1 ）°. In Group Ⅱ ,the average Cobb＇ s angle was（ 1.4 ± 1.5 ） ° postoperatively and later increased to （4.5 ± 2.4） ° at the final folluw-up, with correction loss of （3.1 ±1.1）°. In Group Ⅲ, the mean Cobb＇s angle was （0.0±1.1） ° postoperatively but was increased to （ 1.3 ± 1. 2 ） ° at the last followup, with correction loss of （ 1.3 ± 0. 01 ） °. The three groups showed statistical difference regarding the correction loss of Cobb＇ s angle （ P 〈 0.05 ）. Group Ⅱ and Group m showed no significant differences in aspects of ODI score and Denis work and pain scale at the final follow-up, but the differences were significant when Group Ⅰwas compared with Group Ⅱ and Group m （P 〈0.05）. Conclusions The posterior transvertebral pedicle screw fixation with 4 verte- brae auad 8 screws for adjacent two-segment thoracic and lumbar vertebral fractures is beneficial to gaining well reduction and fixation, maintaining deformity correction, preserving motion segment and releasing pain. The operation, a simple and convenient technique, has the prospect of clinical application.