经伤椎椎弓根钉内固定治疗胸腰椎爆裂骨折

Thoracolumbar burst fractures fixation through the pedicle of fractured vertebrae

目的探讨经伤椎椎弓根钉固定治疗胸腰椎爆裂骨折的临床疗效。方法 58例胸腰椎爆裂骨折患者中36例行传统跨伤椎的4钉固定(A组),22例行经伤椎椎弓根5钉固定(B组)。结果 58例均获随访,时间7～32(13.5±5.4)个月。依据患者伤椎前缘高度、矢状面Cobb角、椎管正中矢状径、神经功能恢复进行临床疗效评价。伤椎前缘高度、矢状面Cobb角、椎管正中矢状径两组术后1周与术前比较差异均有统计学意义(P<0.01);但两组之间比较差异无统计学意义(P>0.05);术后6个月,椎前缘高度、矢状面Cobb角两组比较差异有统计学意义(P<0.05),椎管正中矢状径、神经功能评定两组比较差异无统计学意义(P>0.05)。结论经伤椎椎弓根固定是治疗胸腰椎爆裂骨折的有效方法,较传统跨伤椎固定能更好维持矫正效果。

Objective To investigate the clinical results of internal fixation of thoracolumbar burst fractures with screw through the pedicle of fractured vertebrae arch. Methods In the 58 cases of thoracolumbar burst fracture,36 cases of Group A were performed pedicle screw fixation with the upper and lower segment of the fractured vertebrae ; and 22 cases of Group B were performed internal fixation through the pedicle of fractured vertebrae. Results All the 58 cases were followed up for 7 -32 months （ average 13.5 ±5.4 months）, and 2 groups were comparatively analyzed according to the anterior margin height of the fracture vertebra, Cobb＇s angle, spinal canal middle diameter, nerve functions. Postoperative fractured vertebral height,Cobb＇s angle and spinal canal middle diameter of 2 groups had sig- nificant difference compared with preoperative ones （P 〈 0. 01 ）. No statistical significance （P 〉 0. 05） at 1 week af- ter operation between 2 groups. The anterior margin height of the fracture vertebra and Cobb＇s angle of 2 groups had significant difference（ P 〈 0. 05 ） at 6 months after operation. Spinal canal middle diameter and the nerve functions of 2 groups hadn＇t significant difference （P 〉 0. 05）. Conclusions Internal fixation of thoracolumbar burst fractures with screws through the pedicle of fractured vertebra arch is an effective therapeutic option to treat the thoracolumbar burst fractures, and achieve better outcome than traditional traMsractured vertebral fixation.