经伤椎椎弓根螺钉固定治疗胸腰椎骨折的临床体会

Clinical experience of pedicle screw fixation in treatment of thoracolumbar fractures

目的探讨经伤椎椎弓根螺钉固定技术治疗胸腰椎骨折的临床效果。方法选取本院2009年2月-2012年12月收治的胸腰椎骨折患者104例，采用经伤椎椎弓根螺钉固定技术治疗，分别于手术前、手术后1周内、末次随访时拍摄胸腰椎X线片、CT片，测量伤椎前缘高度、Cobb角、椎管截面积等，观察骨折愈合，内固定物有无松动、断裂和脊髓神经损伤恢复情况，根据美国脊柱损伤协会（ASIA）分级评定脊髓损伤恢复情况。结果随访11～18个月．手术后1周内伤椎椎体前缘高度、Cobb角与手术前比较，差异有统计学意义（P〈0．05）；末次随访时伤椎椎体前缘高度、Cobb角与手术后1周比较，差异无统计学意义（P〉0．05）。随访期间没有发现椎弓根螺钉系统松动、断裂．随访期间患者脊髓损伤功能恢复1-2级。结论经伤椎椎弓根螺钉固定技术治疗胸腰椎骨折行之有效，不仅使伤椎椎体高度恢复满意，矫正后凸畸形，而且可减少椎弓根螺钉系统松动、断裂，是治疗胸腰椎骨折的有效方法，值得临床推广应用。

Objective To study the clinical efficacy of pedicle screw fixation in treatment of thoracolumbar fractures. Methods 104 cases of patients with thoracolumbar fracture admitted in our hospital from February 2009 to December 2012 were selected,and were given with pedicle screw fixation treatment.Before surgery,a week after surgery,the last follow-up,thoracolumbar X-ray,CT slices was shot;the injured vertebra anterior height,Cobb angle,spinal and other cross-sectional area was measured;fracture healing,loose fixation,fracture and spinal cord injury recovery was observed, the recovery of spinal cord injury was assessed by ASIA classification.Results The patients were followed up for 11 to 18 months after operation.The injuries vertebral vertebral height,Cobb angle after 1 week treatment compared with be- fore surgery,the difference was significant （P〈0.05）;injured vertebra vertebral height,Cobb angle at last follow-up com- pared with one week after surgery,the difference was not significant （P〉0.05）.No pediele screw loosening,fracture was found during follow-up.The function in patients with spinal cord injury was recovered 1 to 2 during follow-up period. Conclusion Pedicle screw fixation in treatment of thoracolumbar fractures,not only make the vertebral height recovered satisfactorily,kyphosis correction,but also reduce the loosening of pedicle screw systems,fracture,is an effective method for the treatment of thoracolumbar fractures,and it is worthy of clinical application.