后路单间隙融合双节段固定治疗DenisB型胸腰椎爆裂性骨折

Studies of single segmental spinal interbody fusion with bisegment fixation for thoracolumbar burst fracture of Dennis type B

[目的]总结采用后路单间隙融合双节段固定治疗伴脊髓损伤(spinal cord injury,SCI)的Denis B型胸腰椎爆裂性骨折的临床疗效。[方法]2007年1月～2009年3月,采用后路单间隙融合双节段固定治疗Denis B型胸腰椎爆裂性骨折患者31例。其中男21例,女10例;年龄17～61岁,平均35.5岁。均伴有不同程度脊髓压迫症状。31例均为单节段椎体骨折,其中T114例,T129例,L114例,L24例。伤后距手术时间6 h～3 d,平均2.4 d。观察手术前后及随访阶段均以骨折椎体为中心摄正、侧位X线片。了解术后及随访期间骨折复位丢失情况,有无内固定折断,椎弓根钉松动、拔出,椎弓根钉或内固定圆棒折断等。按美国脊髓损伤协会标准评价神经功能。比较术后1周、术后12个月椎体成角、上下终板成角有无差异,神经功能恢复情况。[结果]所有患者手术切口均Ⅰ期愈合。31例均获随访,随访时间24～48个月,平均26个月。术后1周及术后12个月椎体成角、上下终板成角与术前比较差异有统计学意义(P<0.05),术后12个月与术后1周比较差异无统计学意义(P>0.05)。神经功能有不同程度的恢复。术后随访期间无内固定松动、断裂等并发症发生,植骨融合良好,无植骨不融合、骨吸收、椎体塌陷等情况。[结论]后路单间隙融合双节段固定是治疗Denis B型胸腰椎爆裂性骨折的有效方法。

[Objective]To evaluate the clinical value of the treatment of single segmental spinal interbody fusion with bisegment fixation for thoracolumbar burst fracture of Dennis type B.[Method] From March 2007 to March 2009,31 cases of thoracolumbar burst fracture of Dennis type B with spinal cord injuries underwent posterior exposition,reduction and bisegment fixation with the single segmental spinal interbody fusion.There were 21 males and 10 females with an average age of 35.5 years（range,17-61 years）.The affected locations were T11 in 4 cases,T12 in 9 cases,L1 in 14 cases,and L2 in 4 cases.The time from injury to operation were 6 h-6 days（2.4 days on average）.Radiological outcomes were get before operation,at 1st week and 12th month after operation,which included the vertebral angle,the superior-inferior endplate angle,neurological improvement was assessed according to ASIA grading scale.[Result]All cases were followed up.The average follow-up time were 26 months（range,24-36 months）.There were statistically significant differences（P0.05）in the above two parameters between preoperation and postoperation in vertebral angle,the superior-inferior endplate angle,but there were no statistically significant differences（P0.05）in the vertebral angle,the superior-inferior endplate angle,between 1st week and 12th month.Neurological function improvement were got in all cases except in the 4 cases of grade A.All cases got bone union.The position of internal fixation was good during follow-up.The complications such as disruption,breaking or loosening of the screws or rods and collapse were not observed.[Conclusion]The application of single segmental spinal interbody fusion with bisegment fixation through posterior approach is a satisfactory technique for the treatment of thoracolumbar burst fracture of Dennis type B with SCI.