经伤椎椎弓根置钉固定治疗胸腰椎骨折疗效观察

Via injured vertebral pedicle screw fixation in treatment of thoracolumbar fractures

目的探讨经伤椎置钉椎弓根螺钉系统固定治疗胸腰椎骨折的临床疗效。方法对42例胸腰椎骨折患者施行经伤椎置钉椎弓根螺钉系统固定治疗,手术前后行X线片和计算机体层摄影检查,测量伤椎椎体前缘高度和伤椎矢状面指数(SI),评定治疗效果。结果手术时间90～180 min,平均(120.0±9.6)min,出血量200～2 400 mL,平均(600.0±16.5)mL。患者术后1周及3、6、12个月SI显著小于术前(P<0.05),患者术后1周及3、6、12个月时SI比较差异均无统计学意义(P>0.05)。患者术后1周及3、6、12个月椎体前缘高度显著大于术前(P<0.05);患者术后1周及3、6、12个月时椎体前缘高度比较差异均无统计学意义(P>0.05)。所有患者随访6个月时骨折均完全愈合,随访期间未出现内固定松动、拔钉、钉棒折断等。11例术前下肢神经功能Frankel分级为C、D级患者术后康复,随访3个月,Frankel分级达到E级。结论经伤椎置入椎弓根螺钉的6钉固定方法治疗胸腰椎骨折,椎体高度恢复效果良好,术后伤椎高度丢失减少,内固定牢固,有利于伤椎的融合和神经功能的恢复。

Objective To explore the effect of via injured vertebral pedicle screw fixation for treatment of thoracolumbar fractures.Methods A total of 42 cases of thoracolumbar fractures were treated with via injured vertebral pedicle screw fixation;before and after operation,the patients were examined by X-ray and computed tomography to measure the anterior border height and sagittal index（SI） of injured vertebrae,then the therapeutic efficacy was evaluated.Results The operation time was 90-180 minutes,the average operation time was（120.0±9.6） minutes;the bleeding volume was 200-2 400 mL,the average bleeding volume was（600.0±16.5） mL.The SI at the time points of 1 week and 3,6,12 months after operation was significantly lower than that before operation（P0.05）;but there was no significant difference in the SI among the time points of 1 week and 3,6,12 months after operation（P0.05）.The anterior border height of injured vertebrae at the time points of 1 week and 3,6,12 months after operation was significantly higher than that before operation（P0.05）;but there was no significant difference in the anterior border height of injured vertebrae among the time points of 1 week and 3,6,12 months after operation（P0.05）.All the fractures were fully coalesced when the patients were followed up for 6 months;there was no fixation loosening,pulling nails and nails break during the period of follow-up.Three months after operation,11 patients with Frankel class C and D of lower extremity nerve function before operation recovered to Frankel class E.Conclusion Via injured vertebral pedicle six screws fixation for treatment of thoracolumbar fractures can obtain good effect of vertebral height restoration,less vertebral height loss,and reliable internal fixation;which is conducive to fractured union and neurofunctional recovery.