椎弓根植骨加短节段椎弓根螺钉内固定治疗老年胸腰椎骨折56例

Transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra to treat thoracolumbar fractures in elderly patients

目的：观察椎弓根植骨联合短节段椎弓根螺钉内固定治疗老年胸腰椎骨折的疗效及安全性。方法选取采用椎弓根植骨联合短节段椎弓根螺钉内固定治疗的老年胸腰段骨折病例进行回顾性分析，共纳入56例研究对象。手术前后及随访期间均行X线检查，观察术后植骨情况、并发症发生率及神经功能恢复情况，评估手术前后伤椎椎体前缘高度值、Cobb＇s角、椎管内占位变化等。结果手术时间平均为（136±41） min；术中平均出血量（250±61） ml，术后无感染、骨不连等严重并发症。随访时间6～60个月，术后影像学检查伤椎高度、Cobb＇s角、椎管内占位较术前获得显著改善（P〈0.05），术后1周与末次随访时差异无统计学意义。术后ASIA分级与术前比较差异有统计学意义（P〈0.05），神经功能获得1～2级改善。结论短节段椎弓根螺钉内固定可重建脊柱稳定性，椎弓根植骨可填补伤椎复位后的椎体缺损，维持前中后三柱稳定性，是治疗老年胸腰椎骨折的有效方法。

Objective To explore the clinical efficacy of transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra to treat thoracolumbar fractures in elderly patients. Methods A total of 56 elderly patients with thoracolumbar fractures treated with transpedicular intracorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra were studied retrospectively. Preoperative, postoperative and follow-up X-ray were performed to evaluate anterior heights of the injured vertebra （AHIV） and Cobb＇s angle, as well, preoperative and postoperative CT scans were taken to measure the sagittal canal diameter （SCD）. Postoperative complications and neurofunctional recovery of the spinal cord were evaluated. Results The mean operation time and blooding volume were （136 ± 41） min and （250 ± 61） ml respectively. There was no infection, implant failure or loss of spinal curvatures happened. All cases had been followed up for 6 to 60 months, and anterior heights of the injured vertebra showed good recovery, and Cobb＇s angel appeared smaller. The sagittal canal diameter significantly reduced compared to that before surgery, and the neuro-functions showed 1 to 2 grade improvement compared to preoperation. Conclusion Transpedicular intracorporeal grafting is effective to repair fractured vertebrae in the vertebral body defects, posterior short-segment pedicle screw via the injured vertebra can reconstruct the stability of thoracolumbar fractures, stabilize reconstruction of the anterior and middle columns and secured fixation of the posterior column.