可扩张通道管系统下经伤椎置钉单节段治疗胸腰段骨折的疗效观察

Observation on the Efficacy of Pedicle Screw Placement in Single Segment of the Injured Verte-bral by Quadrant System for the Treatment of Thoracolumbar Fracture

【目的】探讨可扩张通道管（QUADRANT）系统下经伤椎置钉单节段治疗胸腰椎骨折的疗效。【方法】收集胸腰椎骨折患者50例，采用C臂 X线机透视定位，在后路 QUADRANT系统下伤椎置钉单节段内固定植骨融合，对比分析术前、术后神经功能 ASIA分级、伤椎椎体的高度及 Cobb角。【结果】所有患者均得到随访。手术平均切口长度3．5 cm，平均手术时间53 min，术中平均出血量125 mL，1例切口皮缘有坏死，经过对症治疗后愈合。术后所有患者均骨性融合，2例ASIA C级神经功能均恢复至正常，X线检查术后伤椎高度恢复到95．9％，随访椎体高度丢失0．4 mm，丢失率为1．4％；Cobb角由术前19．5°（12．6°～26．4°）恢复到术后4．1°（1．5°～6．3°），无内固定物松动、移位、断裂。【结论】在后路QUADRANT系统下伤椎置钉单节段治疗胸腰段骨折，是一种创伤小、手术时间短、出血量少、疗效好、操作安全的手术方法。

[Obj ective]To explore the efficacy of pedicle screw placement in single segment of the inj ured verte-bra by posterior Quadrant system for the treatment of thoracolumbar fracture.[Methods]Totally 50 patients with tho-racolumbar fracture were collected.After localization by C-arm fluoroscopy,all patients underwent pedicellscrew placement in single segment,internal fixation and bone graft infusion by posterior QUADRANT system.ASIA clas-sification of nerve function,vertebra height and Cobb angle before and after operation were analyzed and compared.[Results]All patients were followed up.The mean incision length was 3 .5 cm.The average operation time was 53min.The average bleeding volume was 125mL.One patient with incision skin edge necrosis was cured by symp-tomatic treatment.All patients after operation had bony fusion.ASIA grade C neural function of 2 patients recovered to normal.Postoperative X-ray examination showed that the inj ured vertebral height recovered to 9 5 .9%.During the follow up,the vertebral height only lost 0.4mm,and the lost rate was 1.4%.The Cobb angle recovered from preop-erative e 19.5°（12.6°～26.4°）to postoperative 4.1°（1.5°～6.3°）.No internal fixation loosening,shift and breakage fracture were found.[Conclusion]Pedicle screw placement in single segment of the inj ured vertebra by posterior Quadrant system for the treatment of thoracolumbar fracture is a surgical method with minimal trauma,short opera-tion time,less blood loss,good efficacy and safe operation.