椎弓根螺钉联合椎板关节突螺钉固定治疗腰椎骨折

Fixation with posterior short-segment pedicle screws and a mono-segment translaminar facet screw totreat fractures of lumbar vertebra

目的探讨后路短节段椎弓根螺钉跨伤椎联合单节段椎极关节突螺钉同定治疗腰椎骨折的效果。方法选择自2011年1月至2012年6月收治的52例腰椎患行，分别采Ⅲ后路短节段椎弓根螺钉跨伤椎固定（A组，27例）和椎弓根螺钉跨伤椎联合单节段椎板关节突螺钉同定（B组，25例）治疗。两组患行术前一般资料比较芹肄均无统计学意义（P〉0．05），具有呵比性。比较两组患者的术前、术后和术次随访时伤椎前缘高度丢失九分比、椎管占位及后凸cobb角的变化，未次随访时的脊柱融合率、脊髓神经Frankel分级、局部疼痛和工作状态。结果所有患者随访12-36个月（平均22．5个月）。A组l例患者于术后16个月出现下方2枚螺钉断裂，两组其他忠行均未发牛内固定物松动或断裂。A、B组融合率分别为88．9％和100％，芹异有统计学意义（P〈0．05）。所有患者的脊髓神经功能均有1-2级的恢复，未次随访时两组间脊髓神经功能Fankel分级和工作状念比较差异均无统计学意义（P〉0．05）。而B组局部疼痛分级优于A组，芹异有统计学意义（P〈0．05）。术后和木次随访时伤椎前缘高度丢火百分比、椎管占化及后凸cobb角矫正度两组间比较差异均尤统计学意义（P〉0．05）。A组后凸cobb角丢失比B组严重，差异有统计学意义（P〈0．05）。结论与后路短节段椎弓根螺钉跨伤椎同定相比，后路矩∞段椎弓根螺钉跨伤椎联合币竹段椎板关节突螺钉同定治疗腰椎骨折加强了脊柱稳定性，提高了融合率．很好地维持了脊柱凸后矫正度，可作为腰椎骨折后路手术治疗的较好选择。

Objective To/nvestigaie the efficacy of fixation across the injureti vertebra with posteriur short-segment pediele screws and a monu-segment translaminar facet screw to treat fractures of lumbar verte-bra. Methods The study reviewed 52 patients （43 males anti 9 females） who had nndergone surgery from January 2011 to June 2012 fur lumbar fractures. Fixation across the injured vertebra with posterior short-segment pediele screws was adopted for 27 cases （group A） and fixation aeross the injured vertebra with posterior short-segment pedicle serews and a mono-segment translaminar facet serew for 25 cases （group B）. The 2 groups were compatible with no signifieant differences in general clinical data （ P 〉 0.05）. The spinal curd funetio, was evaluated according to Frankel＇s scale; the local pain and work status of the patients at the last fulluw-up wel~ evaluated using the Denis scale. Postoperative implant failure and fusion rate. as well as the pain and work status of the palients at the last follow-up, were compared between the 2 groups. The 2 groups were also compared at preoperation, postoperation and the last follow-up in terms of spinal cord func- tion, anterior height loss of the injured vertebra, spinal canal stenosis and cobb angle, Results All patients were fullowed up fur 12 tu 36 months （average, 22.5 months） . No implant loosening or breakage occurred in all the patients except in one case in group A who had implant loosening 16 months postoperation. There was a signifieant differenee ill the fusion rate between group A （88.9%） and group B （100%） （ P 〈 0.05） , All the patients gained an improvement of 1 to 2 grades in neural functinn of the spinal curd. There were no significant differences at the last follow-up between the 2 groups regarding the Frankel＇s evaluation or work status （ P 〉 0.05）, but group B scored significantly better than group A in local pain evaluation （ P 〈 0. 05） . There were no significant differences at postoperation and the last follow-up between tile 2 groupsregarding anterior height loss of the injured vertebra, spinal canal stenosis or correction of cobb angle （ P 〉 0. 05）, but group A had significantly greater loss of cobb angle than group B （ P 〈 0. 05）. Conclusions Compared with conventional transpedicular fixation with posterior short-segment pedicle screws, supplemental fixation with a mono-segment translaminar facet screw can strengthen the spinal stability, increase fusion rate and better maintain the correction of cobb angle. Therefore, it is a good posterior treatment for fractures of lumbar vertebra to adopt fixation with posterior short-segment pedicle screws and a mono-segment translaminar facet screw.