伤椎椎弓根长螺钉在治疗胸腰椎骨折中的应用

Surgical treatment of thoracolumbar fractures by using long pedicle screw of the injuried vertebra

目的探讨伤椎置钉应用长螺钉在胸腰椎骨折的复位作用。方法对62例AO分类为A型及部分B1、B2型胸腰椎骨折患者临床资料进行回顾性分析:均采用后路手术,分析伤椎形态特点,伤椎椎弓根两侧或一侧置入长度与上下椎弓根等长的螺钉,通过长螺钉置顶、撬拨复位等,使压缩、爆裂粉碎椎体恢复正常或近似正常高度及解剖序列,恢复椎管容积,占位>50伴神经症状者在术中减压并需用其他器械辅助进行椎管内骨片复位。结果所有患者均获随访,随访时间12～30月,平均19月,62例患者均伤椎置长钉,共118枚,骨折块复位和椎体高度恢复,Cobb角较术前纠正;其中1例复位不佳,均无后方韧带复合体过撑。结论伤椎置钉技术对胸腰爆裂椎骨折具有良好的即时复位效果,但伤椎长螺钉更加容易复位及维持效果。

Objective To study the effect of the using long pedicle screw of the injured verte- bra in the treatment of thoraeolumbar fractures. Methods For 62 cases with injured vertebral bodies,with type A,BI or B2 according to the AO classification,long pedicle screw were inserted in either unilateral or bilateral side of injured vertebral,The pediele screws in the injured vertebra were used to achieve the ventral press vertical to the distraction for the stress neutralization, and also with the routine distraction and lordosis restoration. Results The mean follow-up period was 19 months with a range from 12 to 30 months.the front after vertebral compression height and lumbar posterior margin compression height and Cobb angle were better compared with the preop- erative area of the spinal canal recovery but one case. and no over distraction of the PLC. Con- clusion Injured vertebra transpedicular fixation can help to achieve a good fixation and restoration of injured vertebra body, and long screw get better effect.