经伤椎固定联合有限开窗减压治疗胸腰椎爆裂性骨折

Treatment of Thoracolumbar Burst Fractures with Limited Decompression and Injured Vertebra Pedicle Screw Fixation

目的探讨经伤椎固定联合有限减压治疗胸腰椎爆裂性骨折的临床疗效。方法2005年10月～2011年10月对38例胸腰段椎体爆裂性骨折采用腰椎后路经伤椎椎弓根钉固定联合有限减压治疗，对患者术前后x线片进行测量和神经功能评价。结果38例随访36个月，均获得骨性融合，无椎弓根钉断裂、弯曲及拔出，术后36个月疗效评价：优36例，良1例，差1例，优良率97．4％（37／38）。术前骨折椎体前缘高度（14．23±2．51）mm，显著低于术后6个月（25．68±3．95）mm（q=22．319，P〈0．05）、术后24个月（26．23±3．15）mm（q=23．391，P〈0．05）和术后36个月（25．64±2．86）mm（q=22．241，P〈0．05）。术前Cobb角24．39。±2．54。，显著大于术后36个月15．54。±1．05。（q=27．448，P〈0．05）。术前VAS评分（6．1±1．1）分，显著高于术后36个月（1．2±0．6）分（q：33．930，P〈0．05）。术前后Frankel分级有统计学差异（Z=-2．190，P=0，029）。结论经伤椎固定微创有限减压治疗胸腰椎爆裂性骨折不仅为爆裂性骨折提供即刻稳定，且具有复位满意、创伤小，远期可防止后凸畸形和固定失败的优点。

Objective To discuss the clinical efficacy of limited decompression and pedicle screw fixation for thoracolumbar burst fractures. Methods From October 2005 to October 2011, 38 patients with thoracolumbar burst fractures were treated by lumbar pediele screw fixation combined with limited decompression. The X-ray measurements and evaluations of neurological functions before and after surgery were reviewed. Results All the 38 cases were followed up for 36 months. The bone fusion was obtained in all the cases, without pedicle screw breakage, bending, or prolapse. Evaluation of the efficacy at 36 months after surgery： excellent in 36 cases, good in 1 case, and poor in 1, with a good-or-excellent rate of 97.4% （37/38）. The preoperative anterior height of fractured vertebrae was （ 14.23 ± 2.51 ） ram, which was significantly lower than that 6 months postoperatively [ （25.68 ± 3.95 ） ram, q = 22.319, P 〈 O. 05 ], 24 months postoperatively [ （ 26.23 ± 3.15 ） ram, q = 23. 391, P 〈 0.05 ], and 36 months postoperatively [ （25.64 ± 2.86） ram, q = 22. 241, P 〈 O. 05 ]. The preoperative Cobb angle was （24.39 ° ± 2.54 °） , which was significantly more than that 36 months after surgery[ （15.54 ° ＋ 1.05 °）, q = 27. 448, P 〈 0.05 ]. The preoperative VAS scores were （6. 1 ± 1. 1 ） points, which were significantly higher than that 36 months after operation [ （ 1.2 ± 0.6） points, q = 33. 930, P 〈 0.05 ]. There were significant differences in the Frankel grades before and after the operation （ Z = - 2. 190, P = 0. 029 ）. Conclusion Limited decompression and pedicle screw fixation for thoracolumbar burst fractures can not only provide instant stability, but also have advantages of high satisfaction rate, minimal invasion, and long-term prevention of kyphosis and fixation failure.