椎弓根螺钉固定椎间植骨融合治疗胸腰椎骨折脱位

Pedicle screw fixation with posterior lumbar interbody graft fusion for thoracolumbar fracture dislocation

目的：探讨椎弓根螺钉固定椎间植骨融合治疗胸腰椎骨折脱位的疗效。方法对21例胸腰椎骨折脱位患者采用椎弓根螺钉固定椎间植骨融合治疗。比较术前、术后1周及3、6、12个月Frankel分级变化，复查X线片和CT三维重建，测量椎间隙前后缘高度、Cobb角、观察植骨融合情况，评价临床效果。结果患者均获随访，时间12～24（14.5±5.2）个月。骨折脱位均获得复位。无神经、血管损伤、内固定松动断裂等并发症。脊髓神经功能均有不同程度恢复。影像学显示椎体间距稳定，植骨在术后3～6个月均获骨性融合。术后1周和3、6、12个月Cobb角分别为-0.12°±1.89°、0.10°±1.92°、0.12°±1.98°、0.14°±2.54°，与术前（22.89°±10.97°）比较差异均有统计学意义（P＜0.01）。椎间隙前、后缘高度术后1周和3、6、12个月分别为：（10.56±6.23）mm、（9.85±5.54）mm，（10.45±5.96）mm、（9.12±5.57）mm，（10.46±6.12）mm、（9.98±5.75）mm，（10.41±6.11）mm、（9.07±6.01）mm；与术前（-3.23 mm ±1.56 mm、1.89 mm ±2.65 mm）比较差异均有统计学意义（P＜0.01）。结论后路椎间融合椎弓根螺钉固定治疗胸腰椎骨折脱位能够提供解剖复位和坚强内固定，达到术后早期稳定和植骨融合的疗效。

Objective To investigate the efficacy of pedicle screw fixation with posterior lumbar interbody graft fusion for the treatment of thoracolumbar fracture-dislocation.Methods 21 cases of thoracic lumbar fracture-dislocation were treated by pedicle screw fixation with posterior lumbar interbody graft fusion.Preoperative and postoperative 1 week,3 months,6 months,12 months Frankel grading change were compared.The clinical results was evaluated by review the X-ray and CT reconstruction,measurement around the edge of the disc space height,observation and fu-sion of the Cobb angle.Results All patients were followed up for 12 ~24 months,with an average of 14.5 ±5.2 months.Patients with fracture dislocation were reduced.There were no nerve,vascular damage,fixation loosening and other complications.Spinal cord function got different levels of recovery,radiographic vertebral spacing was stabe,and bone graft in 3~6 months after surgery were bone fusion.After 1 week,3 months,6 months,12 months, Cobb angle was -0.12°±1.89°,0.10°±1.92°,0.12°±1.98°,0.14°±2.54°.The difference was statistically sig-nificant between the preoperative（P〈0.01）.The altitude of intervertebral anterior and posterior after operation 1 week,3 months,6 months,12 months was （10.56 ±6.23）mm and （9.85 ±5.54）mm,（10.45 ±5.96）mm and （9.12 ±5.57）mm,（10.46 ±6.12）mm and （9.98 ±5.75）mm,（10.41 ±6.11）mm and （9.07 ±6.01）mm;there was statistically significant difference between preoperative（-3.23 mm ±1.56 mm,1.89 mm ±2.65 mm）and postoperative（P〈0.01）.Conclusions Pedicle screw fixation with posterior lumbar interbody graft fusion for thora-columbar fracture dislocation can provide anatomic reduction and rigid internal fixation to achieve the efficacy of early postoperative stability and interbody bony fusion.