经后路椎弓根螺钉内固定治疗胸腰椎骨折的临床效果

Clinical efficacy of pedicle screw internal fixation through posterior approach in treatment of thoracolumbar fracture

目的探讨经后路椎弓根螺钉内固定系统治疗胸腰椎骨折的临床效果。方法收集2009年1月至2012年6月经后路切开复位椎弓根螺钉内固定治疗的胸腰椎骨折患者62例,并分析其临床效果及并发症。结果 8例完全瘫痪者神经功能无恢复,33例不完全瘫痪者均有1级或1级以上的神经功能恢复,21例无神经症状;术后脊髓损伤严重程度评定标准(Frankel分级)A级8例,B级0例,C级3例,D级5例,E级46例;伤椎前后缘高度由术前(15.1±3.8)、(24.9±3.1)mm分别恢复至术后(27.5±4.5)、(29.3±2.1)mm,Cobbs角由术前平均(21.3±5.2)°恢复至术后平均(9.7±3.6)°;CT检查发现27例椎体内有空隙;41例行横突间植骨仅5例融合,其余椎板间及小关节突周围植骨融合较好;内固定螺钉松动9例。结论经椎弓根螺钉内固定手术能有效恢复伤椎椎体高度和脊柱生理弧度,使移位骨折块复位并坚强固定,是治疗胸腰椎骨折的有效方法。

Objective To study the clinical efficacy of pedicle screw internal fixation through posterior approach in the treating thoracolumbar fracture.Methods 62 cases of thoracolumbar fracture treated by pedicle screw internal fixation through posterior approach from January 2009 to June 2012 were collected,and their clinical efficacy and complications were analyzed.Results The nervous function in 8 cases of complete paralysis had no recovery,and 33 cases of incomplete paralysis had recovered nervous function with the grade 1 or more than the grade 1 and 21 cases had no nervous symptoms.The Frankel classification after surgery was the grade A in 8 cases,the grade B in 0 case,the grade C in 3 cases,the grade D in 5 cases and the grade E in 46 cases.The anterior and posterior height of injured vertebral bodies recovered from（15.1±3.8）mm and（24.9±3.1）mm before surgery to（27.5±4.5） mm and 29.3±2.1mm after surgery,respectively.The Cobb angle recovered from the average（21.3±5.2）° before surgery to the average（9.7±3.6）° after surgery.Postoperative CT showed that 27 cases had interspace between vertebral bodies,among 41 cases of intertransverse bone graft,only 5 cases had bony fusion,and the other peripheral bone grafts of inter-vertebral plate and little processus articularis had better bony fusion and 9 cases had loosened pedicle screws of internal fixation.Conclusion Pedicle screw internal fixation through posterior approach is effective in treating thoracolumbar fracture,which can effectively recover the height of injured vertebral bodies and the spine physiological radian,and can reset fracture block and make the fracture fixed strongly.