后路短节段钉棒系统结合经伤椎置钉固定治疗胸腰椎爆裂性骨折

Posterior short-segment pedicle screw system combined with pedicle screw fixation of fracture vertebra in treatment of thoracolumbar burst fractures

目的探讨短节段经伤椎椎弓根螺钉固定治疗胸腰椎爆裂性骨折的临床疗效。方法对36例胸腰椎爆裂性骨折经伤椎行短节段椎弓根螺钉固定。术后定期X线复查患者的椎体高度、Cobb角、椎管矢状径占有率；对神经功能ASIA分级进行分析。结果患者均获得随访，时间6—24个月，植骨均获骨性愈合。末次随访时伤椎高度由术前的43．2％±1．8％恢复至91．0％±2．O％，Cobb角由术前24．2°±3．0°恢复至5．0°±1．0°，椎管矢状径由术前的60．2％±8．7％增加到85．5％±12．8％。术后神经功能ASIA分级：除2例A级无变化外，其余均有1～2级恢复。未出现螺钉松动及断裂。结论经伤椎椎弓根螺钉椎体固定治疗胸腰椎爆裂性骨折矫正度丢失小，疗效满意。

Objective To investigate the clinical effect of short-segment transpedicular screw fixation combined with pedicle screw fixation of fracture vertebra in treatment of thoraeolumbar burst fractures. Methods 36 cases of thora- columbar burst fractures were treated with vertebral short-segment pedicle screw fixation combined with pedicle screw fixation of fracture vertebra. After regular time of X-ray examination, patients were evaluated with vertebral height, Cobb angle, on the sagittal plane encroachment of spinal canal. Analysis of neural function grade of ASIA changes was performed. Results The patients were followed up for 6 - 24 months, all bone graft healed. After 24 months of follow-up, vertebral height was restored from preoperative 43.2% ＋ 1.8% to 91.0% -＋2.0% , Cobb angle from pre- operative 24. 2~ ＋- 3.0~ restored to 5.0~ -＋ 1.0~ , sagittal plane encroachment of spinal canal restored from 60. 2% -＋ 8.7% to 85.5% -＋ 12. 8%. Hierarchical ASIA neural function after surgery： neural function in addition to no change in 2 cases of Grade A, the rest was 1 - 2 level recovery. No screw loosening and fracture was found. Conclusions Transpedicular screw fixation combined with pedicle screw fixation is effective for the treatment of thoracolumbar vertebrae burst fracture with little loss of correction, and curative effect is satisfaction.