经伤椎椎弓根钉内固定并椎体内植骨治疗胸腰椎爆裂性骨折的疗效评价

Transpedicular fixation combined with bone grafting in treatment of thoracolumbar burst fractures

目的:评价经伤椎椎弓根钉内固定并椎体内植骨治疗胸腰椎爆裂性骨折的临床疗效。方法:22例胸腰椎爆裂性骨折患者,全部给予椎弓根钉内固定并椎体内植骨治疗,观察术后椎体前缘高度、脊柱Cobb's角、腰背痛、神经功能恢复情况,以及术后并发症等。结果:所有患者均获随访,随访时间平均为14个月(12～18个月)。22例患者术后疼痛明显缓解(VAS评分明显改善),术后伤椎前缘平均高度恢复到95%,脊柱Cobb's角平均为3°,手术前后差异显著(P<0.05)。术后神经功能恢复情况:C级3例,D级4例,E级15例。术后骨折均获得理想复位,未发现椎弓根螺钉松动、断钉、内固定失效等并发症发生。结论:经伤椎椎弓根螺钉内固定并伤椎椎体内植骨术能让骨折获得理想复位,重建伤椎前中柱高度,增强脊柱的抗压稳定性,减少内固定因应力过大造成的内固定失效、矫正丢失等并发症。

Objective： To explore the outcomes of transpedieular fixation combined with bone grafting in treatment of tboracolumbar burst fractures. Methods. Twenty--two cases of thoracolumbar burst fractures were treated with transpedicular fixation combined with bone grafting and then anterior heights of the injured vertebra, Cobb＇s angle, back pain, nerve function recovery and postoperative compli- cations were observed. Results.. According to an average 14 months follow up conducted on all cases （12 to 18 months）, all patients got their pain relieved distinctly, the averaged height of anterior border was in- creased to 95%, the averaged Cobb＇s angle was 3°, showing significant difference（P〈0.05）before and af- ter operation. The postoperative neurological function was improved： Grade C for 3 patients, Grade D for 4 patients and Grade E for 5 patients. All the fractures were reduced without loose and break of the inter- nal fixation, and there was no lost of correction or other complications. Conclusion：Transpedicular fixation combined with bone grafting not only reduces verbebral fracture satisfactorily, increases the stability of spine, but also decreases the possibility of breaking nail and correction loss. Therefore, it seems an effec-tive method of treating thoracolumbar burst fractures.