经伤椎椎弓根螺钉加强内固定＋植骨治疗胸腰段椎体骨折

Strengthened transvertebral pedicle screw fixation plus bone grafting for treatment of thoracolumbar vertebral body fractures

目的探讨经后路骨折椎椎弓根钉加强固定＋伤椎植骨治疗胸腰段椎体骨折的方式、选择和疗效。方法回顾性分析2008年3月-2013年3月收治的胸腰椎单一椎体骨折患者202例，其中89例加用伤椎螺钉固定（5钉组16例，6钉组73例），设为A组；113例采用传统伤椎邻椎固定（4钉组），设为B组。A组年龄21～71岁，平均39．2岁；B组年龄19～67岁，平均40．4岁。患者受伤至手术时间均住10d内，A组骨折椎一侧或双侧椎弓根无骨折，一侧完整使用5钉固定，双侧完整使用6钉固定。术中经椎弓根撬拨复位骨折并椎体植骨，经骨折椎椎弓根钉向腹侧推挤伤椎，纠正伤椎后凸，分段撑开伤椎。术后随访6～30个月，平均16个月。结果经伤椎椎弓根固定治疗胸腰椎骨折，降低了伤椎经矫正后高度丢失的概率。随访1周和1年时5钉组和6钉组的椎体高度恢复程度较4钉组明显改善[6钉组分别为（135．2±10．6）％、（134．6±9．9）％；5钉组分别为（136．1±10．3）％、（135．9±9．5）％；4钉组分别为（133．8±9．8）％、（132．5±9．1）％]，术后Cobb角也有明显改善[6钉组分别为（2．0±1．2）°、（2．1±1．6）°；5钉组分别为（2．2±2．4）°、（2．5±1．8）°；4钉组分别为（5．8±3．4）°、（6．7±5．5）°]。结论对胸腰椎单一椎体骨折选择性应用伤椎椎弓根螺钉＋植骨有利于矫正压缩程度和后凸畸形，可有效维持矫形效果，骨折愈合后伤椎骨质强度接近正常，近期疗效良好。

Objective To investigate the methods, choices and effects of strengthened posterior pedicle screw fixation plus bone grafting for thoracolumbar vertebral body fractures. Methods A retrospective study was made on 202 patients with single tboracolumbar vertebral body fractures treated between March 2008 and March 2013. Totally, 89 out of the patients at age ranging froln 21-71 years （ mean, 39.2 year） undergone transvertebral pedicle screw fixation were allocated to Group A （ including 16 patients as five screw group and 73 patients as six screw group）. While other 113 patients at age of 19-67 years （mean, 40.4 years） undergone traditional surgery were set as Group B （four screw group）. Surgeries were performed within 10 days postinjury. Patients in Group A presented with intact pedicles on eilher unilateral or bilateral sides, with five screws placed for only single side of intact pedicle and six screws for bilateral intact pedicles. Fractured vertebra was recovered by percutaneous leverage reduction and bone grafting. Kyphosis was corrected by transpedicular pushing the fractured vertebra to the ventral side. Follow-up of the patients lasted for 6 to 30 months （mean, 16 months）. Results Transvertebral pedicle screw fixation reduced the probability of correction loss of vertebral height. At postoperative oneweek and one year, height restoration of vertebral body in five screw group [ （ 136.1 ± 10.3 ） % , （ 135.9 ± 9.5 ） % ] and six screw group [ （ 135.2 ± 10.6） %, （ 134.6 ± 9.9 ） % ] improved significantly from that in four screw group [ （ 133.8± 9.8 ） % , （ 132.5 ± 9.1 ） % ] ; Cobbg angle also achieved significant improvement in five screw group [ （2.2 ± 2.4） °, （2.5 ±1.8） °] and six screw group [ （2.0 ±1.2）°, （2.1 ±1.6） ° ] as compared with that in four screw group [ （5.8 ± 3.4） °, （6.7 - 5.5） ° ]. Conclusions Selective use of transvertebral pedicle screw fixation plus bone grafting provides valid correction of the compressed vertebral body and kyphotic deformity and preservation of orthopedic effect. Bone strength almost returns to normal after fracture healing and short-term result is satisfactory.