伤椎单侧椎弓根置钉联合对侧椎弓根椎体内植骨治疗胸腰段脊柱骨折

Unilateral vertebral pedicle screw combined with contralateral pedicle bone grafting in treatment of thoracolumbar spinal fracture

目的探讨伤椎单侧椎弓根置钉联合对侧椎弓根椎体内植骨治疗胸腰段脊柱骨折的临床效果。方法选取本院2010年10月～2011年12月胸腰段脊柱骨折患者37例,均行伤椎单侧椎弓根置钉联合对侧椎弓根椎体内植骨治疗,术后随访1年,分析患者手术前后的临床指征、临床疗效、并发症情况。结果患者的手术时间为139～204min,平均(168.7±40.6)min,术中出血量为502～714mL,平均(591.8±176.3)mL,术后24h伤口引流量为237～375mL,平均(285.1±63.9)mL,骨折愈合时间为14～20周,平均(15.7±3.1)周。术后伤椎前缘高度、伤椎后缘高度均明显高于术前,术后Cobb角明显小于术前,术后Frankel分级情况明显好于术前,差异均有统计学意义(P<0.05)。手术成功率为100.0%。1例患者发生感染,并发症发生率为2.7%。结论伤椎单侧椎弓根置钉联合对侧椎弓根椎体内植骨是治疗胸腰段脊柱骨折的有效方法,可明显改善患者的临床指征,改善患者预后,临床疗效显著,值得临床推广使用。

Objective To investigate clinical effect of unilateral vertebral pedicle screw and contralateral pedicle bone grafting in treatment for thoracolumbar spinal fracture. Methods Thirty-seven patients with thoracolumbar spinal frac- ture were selected in hospital from October 2010 to December 2011,who were treated with unilateral vertebral pedicle screw and contralateral pedicle bone grafting. Patients were followed up for 1 year. Indications before and after opera tion, clinical effect, complications were analyzed. Results Operation time was 139-204 min, average of （168.7＋40.6）min. Bleeding volume was 502-714 mL average of （591.8＋176.3） mL. 24 h postoperative wound drainage was 237-375 mL, average of （285.1~63.9） mL. Fracture healing time was 14-20 weeks, average of （15.7~3.1） weeks. Postoperative verte- bral height of front edge and fiaek edge were significantly higher than that before treatment. Postoperative Cobb angle was signifieantly smaller than that before treatment. Postoperative Frankel grade was signifieantly better than that be- fore treatment, the differences was statistically significant （P 〈 0.05）, Success rate of operation was 100.0%. 1 patient occurred infection. Rate of complications was 2.7%. Conelusiort Unilateral vertebral pediele screw combined with contralateral pedicle bone grafting is effective method in treatment of thoracolumbar spinal fracture, which can obvi- ously improve clinieal indications and prognosis .Clinieal effect is remarkable, That is worthy of clinical use.