经伤椎固定联合椎弓根植骨治疗胸腰椎骨折

Treatment of thoracolumbar fractures with vertebral pedicle screw fixation combining transpedicular bone graft

目的探讨经伤椎置入螺钉结合经椎弓根植骨治疗胸腰椎骨折的临床疗效。方法对42例胸腰椎骨折实施经伤椎椎弓根钉固定结合经椎弓根植骨术治疗,术前伤椎前缘高度比平均36%,脊柱后凸角（Cobb角）25°,椎管正中矢状径60%,神经功能按Frankel分级：A级2例,B级9例,C级11例,D级10例,E级10例。结果术后随访6-30个月,42例患者术后疼痛明显缓解,术后伤椎前缘平均高度比恢复到95%,脊柱后凸角（Cobb角）为3.5°,椎管正中矢状径恢复到96%,手术前后差异显著（P〈0.05）。术后神经功能恢复情况：A级1例,B级4例,C级4例,D级5例,E级28例。术后骨折均获得复位,无一例发生内固定断裂、松动,矫正丢失等并发症。结论经伤椎椎弓根钉固定结合经椎弓根植骨术能让骨折获得满意复位,重建椎体高度,增强脊柱的抗压稳定性,减少内固定断裂和椎体高度丢失等并发症,是一种治疗胸腰椎骨折的有效方法。

Objective To investigate curative effect for thoracolumbar fractures by the method of vertebral pedicle screw fixation with transpedicular bone graft,and consider its indications. Methods A total of 42 cases of thoracolumbar burst fractures were treated by vertebral pedicle screw fixation combining transpedicular bone graft. The average percent of anterior vertebral height was36% before the operation,the average of Cobb＇s angle was 25°,the percentage of mid-sagital diameter was 60%. According to Frankel＇s neurological function classification,preoperative neurological function was Grade A in 2 cases,B in 9 cases,C in 11 cases,D in 10 cases and E in 10 cases. Results All cases were followed up for 6 to 30 months. All patients＇ pain relieved distinctly,the average percent of anterior vertebral height was increased to 95%,the average of Cobb＇s angle was 3. 5°,the percentage of midsagital diameter was 96% postoperatively,showing significant differences（ P〈0. 05） before and after operation. The postoperative neurological function was improved： Grade A in 1 case,Grade B in 4 cases,Grade C in 4 cases,Grade D in 5 cases,Grade E in 28 cases. All the fractures were reduced and the internal fixation didn＇t loose and break,and there no lost of correction and other complications. Conclusion Vertebral pedicle screw fixation with transpedicular bone graft can not only reduce verbebral fracture satisfactorily,increasing the stability of spine,but also decrease the possibility of breaking nail and correction loss. Therefore it is an effective method of treating thoracolumbar burst fractures.