后路减压经椎弓根植骨配合脊柱后路内固定术治疗中上段胸椎新鲜爆裂骨折24例疗效观察

Clinical effects of posterior decompression and fixation with trans-pedicle bone graft on 24 cases of fresh upper and middle thoracic spine burst fracture

目的观察后路减压经椎弓根植骨配合脊柱后路内固定术治疗中上段胸椎新鲜爆裂骨折的疗效。方法对2007年1月至2012年12月收治的24例中上段胸椎新鲜爆裂骨折患者的临床资料进行回顾性研究。其中，男20例，女4例；年龄18～54岁，平均32．4岁；骨折累及节段：T21例，T32例，T44例，T53例，T66例，T78例，T83例，1、92例，T102例；均合并脊髓损伤，神经损伤按Frankel分级：A级6例，B级5例，c级7例，D级6例。均行脊柱后路减压内固定、经椎弓根植骨术。结果所有患者术后获6～48个月（平均13个月）随访。18例患者神经功能有1～2级的改善，6例A级患者无改善。所有患者植骨融合良好，均无钢板、螺钉松动或断裂发生。对24例患者的cobb角、椎体前、后缘高度、椎管狭窄率进行评价，术后即刻、术后1年与术前比较均有改善，差异有统计学意义（P〈0．05），而术后即刻与术后1年比较差异无统计学意义（P〉0．05）。结论应用后路减压经椎弓根植骨配合脊柱后路内固定术治疗中上段胸椎新鲜爆裂骨折，具有减压彻底、术后脊柱稳定性好和植骨融合率高等优点。

Objective To explore the clinical effects of posterior decompression and fixation with transvertebral pedicle bone graft in the treatment of fresh upper and middle thoracic spine burst fracture. Methods A retrospective study was made on 24 cases of fresh upper and middle thoracic spine burst fracture hospitalized for treatment from January 2007 to December 2012, including 20 male and 4 female patients, with an age range between 18 and 54, averaging 32.4 years. Bone fracture were involved in the following seg- ments： T2 （ 1 case ） , T3 （ 2 cases） , T4 （ 4 cases） , T5 （ 3 cases） , T6 （ 6 cases） , T7 （ 8 cases） , T8 （3 cases） , T9 （ 2 cases） , T10 （2 cases） , with all the cases complicated with spinal cord injury. In accordance with the Frankel classification system, neural in- jury was classified： 6 cases of Grade A, 5 cases of Grade B, 7 cases of Grade C and 6 eases of Grade D. All eases underwent posterior spinal cord decompression and internal fixation with bone grafting of transvertebral pedicle. Results All the patients had medical follow- up for 6 to 48 months, averagingl3 months. Results indicated that 6 cases with Grade A had no improvement in neurological function and 18 cases with grade B, C and D had 1 to 2 levels of improvement. Bone graft fusion was quite well in all the patients, all without loosening or breaking of steel plates, bolts and screws. Evaluation on Cobb angle, the height of anterior and posterior vertebral body, and the rate of vertebral canal stenosis indicated that improvement could be seen in the 24 patients, the moment after surgery and one year after surgery, as compared with that before surgery（P 〈 0.05 ）. Conclusion Posterior spinal decompression and internal fixation in transvertebral pedicle bone grafting had the following advantages： complete decompression, better spinal stability after surgery and high bone fusion rate in the treatment of fresh upper and middle thoracic spine burst fracture.