经胸椎肋横突结合区椎弓根外螺钉固定治疗中上胸椎骨折

The rib-transverse process region extrapedicular internal fixation treating the middle and upper thoracic spine fractures

目的总结中上胸椎椎弓根外置钉技术，评价其临床疗效。方法2005年～2011年，我科共采用经胸椎肋横突结合区椎弓根外固定治疗中上胸椎骨折6例，通过术后正侧位x光片、CT（矢状位、横断面重建）评估螺钉的位置，通过随访观察内固定的稳定性以及神经功能情况。结果6例患者中，术中置钉过程中没有患者出现螺钉穿破椎弓根内壁，术后未出现脊髓损伤及神经症状加重，手术平均矫正后凸7°；在平均12．5月的随访中，无患者出现断钉及螺钉脱出情况，1例患者神经功能Frankel分级由D级恢复到E级。结论在中上胸椎，椎弓根外置钉内固定是一种安全有效的固定方式。

Objective Introduce and assess the extrapedicular screw technique in the middle and upper thoracic spree. Methods From 2005 to 201 l, 6 patients with thoracic spine fractures were treated with fib-transverse process region ex trapedicular internal fixation, we assessed the patients＇ screw position by the X-ray, CT （sagittal, transverse reconstruction） after surgery, reviewed the stability of internal fixation and recovery of neurological symptoms through follow-up. Results In all 6 patients, no patient had pedicle screw perforation during operation, no patient happened with spinal cord injury or got worse of the neurological symptoms. The average correction of kyphosis was 7°. In an average of 12.5 months follow-up, no broken nails or screws prolapsed happened, a patient with spinal cord injury recovered from grade D to the E. Conclusion In the middle and upper thoracic, the fib-transverse process region extrapedicular internal fixation is a safe and effective fixation method.