胸腰椎骨折伤椎复位技术的改进及临床应用

Modification and clinical application of reduction through the pedicle of fractured vertebra in the treatment of thoracolumbar fracture

背景：胸腰椎骨折伤椎复位效果经常不满意，手术方式仍有争议。 目的：探讨经伤椎椎弓根置钉撬拨复位联合短节段内固定治疗胸腰椎骨折的疗效。 方法：回顾性分析2010年8月至2012年10月40例行经伤椎椎弓根置钉撬拨复位短节段内固定的单节段胸腰椎骨折患者的临床资料。其中男32例，女8例，年龄23-63岁，平均45岁。比较患者手术前后伤椎前后缘高度比（伤椎前后缘高度与相邻上、下椎体前后缘高度平均值之比）、矢状面Cobb角、神经功能，进行疗效评价。 结果：患者随访6-18个月，平均12个月，无内固定失败发生。术前有神经功能不全损害的4例患者获得完全恢复。患者矢状面Cobb角由术前平均17.4°±8.0°恢复到术后2.1°±5.7°（P=0.000）；伤椎前缘平均高度比由术前52.7%±13.2%恢复到术后91.2%±9.4%（P=0.000）；伤椎后缘平均高度比由术前92.6%±8.3%恢复到术后98.5%±2.9%（P=0.005）。 结论：对于单节段胸腰椎骨折患者，伤椎椎弓根置钉撬拨复位联合短节段内固定的治疗方法是安全、有效的。

Background：The reduction of fractured thoracic and lumbar vertebra is often unsatisfactory, and the appropriate operation is still controversial. Objective：To evaluate the efficacy of pedicle instrumentation and poking reduction through the pedicle of fractured verte-bra in combination with short segment of pedicle screw fixation in the treatment of thoracolumbar fracture. Methods：Forty patients with single segment thoracolumbar fracture received pedicle instrumentation and poking reduction through the pedicle of fractured vertebra in combination with short segment of pedicle screw fixation from August 2010 to October 2012. There were 32 males and 8 females with an average age of 45 years （range from 23 to 63 years）. The anterior and posterior vertebral body height, sagittal Cobb angle and nervous function were assessed before and after surgery. Results：The mean follow-up duration was 12 months （range, 6-18 months）. There was no internal fixation failure. Four pa-tients who had an associated neurologic deficit were completely recovered. The sagittal Cobb angle decreased from 17.4° ± 8.0° preoperatively to 2.1°±5.7° postoperatively （P=0.000）. The mean ratio of injured anterior vertebral body height to nor-mal vertebra increased from 52.7%±13.2%preoperatively to 91.2%±9.4%postoperatively （P=0.000）. The mean ratio of in-jured posterior vertebral body height to normal vertebra increased from 92.6%±8.3%preoperatively to 98.5%±2.9%postop-eratively （P=0.005）. Conclusions：Pedicle instrumentation and poking reduction through fractured vertebra in combination with short segment of pedicle screw fixation is safe and effective for single segment thoracolumbar fracture.