后路短节段椎弓根钉结合经椎弓根植骨治疗胸腰椎爆裂性骨折

Short-segment posterior pedicle screw combined with vertebral arch bone grafting for thoracolumbar burst fractures

目的：分析后路短节段椎弓根钉结合经椎弓根植骨治疗胸腰椎爆裂性骨折的临床疗效。方法：自2008年3月至2013年3月，采用后路短节段椎弓根钉结合经椎弓根植骨内固定治疗胸腰椎爆裂性骨折62例，其中男40例，女22例；年龄17-65岁，平均38岁。按AO分型：A3．1型34例，A3，2型7例，A3．3型21例。载荷评分4～6分，平均5-4分。根据ASIA脊髓神经功能损伤分级：C级2例，D级5例，E级55例。术前、术后3d及末次随访行X线及CT检查，测量并比较Cobb角、椎体前缘相对高度及椎管占位程度，同时观察椎体骨愈合情况及神经功能恢复情况。结果：62例均获随访，时间11-14个月，平均12．2个月。内固定拆除时间9～13个月，平均11．5个月。术后1例切口出现感染，经清创引流后愈合，2例术后出现轻度腰背部疼痛。术后半年ASIA脊髓神经功能损伤分级：C级1例，D级3例，E级58例。未次随访X线及CT显示所有骨折及植骨愈合良好。术后3d，Cobb角、椎体前缘相对高度、椎管占位程度均较术前有明显改善（P〈0．05），末次随访与术后3d比较Cobb角、椎体前缘相对高度、椎管占位程度无明显变化（P〉0．05）。结论：后路短节段椎弓根钉结合经椎弓根植骨是治疗胸腰椎爆裂性骨折较理想的方法，能够减少术后复住的丢失和防止内固定失败的发生。

Objective ：To analyze the clinical effects of short-segment posterior pedicle screw combined with transpedicle vertebral bone grafting in treating thoracolumbar burst fractures. Methods：From March 2008 to March 2013,62 patients with thoracolumbar burst fractures were treated with short-segment posterior pedicle screw combined with transpedicle vertebral bone grafting. Including 40 males and 22 females ,the age from 17 to 65 years old with an average of 38 years. According to AO classification,34 cases were type A3.1,7 cases were type A3.2 and 21 cases were type A3.3. Load-sharing scores were from 4 to 6 points with an average of 5.4 points. According to ASIA grade, 2 cases were grade C, 5 cases were grade D and 55 cases were grade E. Preoperative, postoperative at 3 d and final follow-up,the Cobb angle,the relative height of anterior vertebral body and the encroachment rate of spinal canal were measured by X-ray films and computed tomography （CT） scan, meanwhile, the information of bone healing and spinal nerves recovery were observed. Results：All patients were followed up from 11 to 14 months with an average of 12.2 months. The duration of removing internal fixation were from 9 to 13 months （averaged, 11.5 months）. One suffered from infection and was cured by debridement. Two cases had mild pain of back. At 6 months after operation, according to ASIA grade to evaluate never function, 1 case was grade C, 3 cases were grade D and 58 cases were grade E. X-ray and CT showed the fractures obtained good union at final follow-up. The Cobb angle, the relative height of anterior vertebral body and the encroachment rate of spinal canal had obviously improved at 3 days after operation （P〈0.05） ;but there was no significant differences between postoperative at 3 d and final follow-up （P〉0.05）. Conclusion：Short-segment posterior pedicle screw combined with transpedicle vertebral bone grafting is an effective method to treat thoracolumbar burst fractures. It can reduce the loss of postoperative correction and prevent the internal fixation failure.