椎弓根钉棒内固定治疗胸腰段骨折脱位的临床研究

Clinical study of treating thoracolumbar fracture and dislocation by pedicle screw rod internal fixation

目的探讨椎弓根钉棒内固定治疗胸腰段骨折脱位的临床疗效。方法选择50例胸腰段骨折脱位患者,采用椎弓根钉棒内固定治疗,观察内固定前、内固定术即时及随访12个月时脊髓损伤恢复情况,病椎前后缘高度百分比、Cobb角的恢复及并发症发生情况。结果 50例胸腰段骨折脱位患者均获得随访,随访时间为12个月。内固定后即时、随访12个月时,病椎的前后缘高度百分比较内固定前明显提高(P<0.01),Cobb角较内固定前明显降低(P<0.01),而内固定后即时与随访12个月比较,病椎前后缘高度百分比、Cobb角比较差异无统计学意义(P>0.05)。内固定前脊髓损伤主要分布于B级和C级,内固定后即时、随访12个月时主要分布于D级和E级,内固定后即时、随访12个月时脊髓损伤分布与内固定前比较差异有统计学意义(P<0.01),而内固定后即时与随访12个月时的脊髓损伤分布差异无统计学意义(P>0.05)。结论针对胸腰段骨折脱位患者,采用椎弓根钉棒内固定术治疗,能有效地恢复病椎的高度,促进受损脊髓神经的功能,且疗效稳定,值得临床借鉴。

Objective To investigate the clinical curative effect of treating thoracolumbar fracture and dislo-cation with pedicle screw rod internal fixation .Methods Fifty patients with thoracolumbar fracture and dislocation were collected , who were treated with pedicle screw rod fixation .The condition of spinal cord injury recovery , the percentage of anterior and posterior edge height of disease vertebral , the occurrence of complications and the condition of Cobb angle recovery were observed before internal fixation , at immediate after internal fixation and at a followed-up of 12 months.Results Fifty patients were followed up for 12 months.The percentage of anterior and posterior edge height of disease vertebrae at immediate after fixation , at a followed-up of 12 months were increased evidently than those before fixation （ P〈0.01 ） , the Cobb angle was decreased obviously than before fixation （ P〈0.01 ） .Between the time points at immediate after fixation and at a followed-up of 12 months, the percentage of anterior or posterior edge height of disease vertebra and Cobb angle had no significant differences （ P〉0.05 ） .Before internal fixation , the spinal cord injury mainly distributed at B level , C level, but at immediate after internal fixation and at a followed-up of 12 months after internal fixation , they distributed mainly in D level and E level , anterior spinal cord injury distri-bution at instant after internal fixation and at a followed-up of 12 months after internal fixation had significant differ-ence from that before internal fixation （ P〈0.01 ） , and between the time point at immediate after internal fixation and the time point at 12 months followed-up after internal fixation , the distribution of spinal cord injury had no significant differences（P〉0.05）.Conclusion For patients with thoracolumbar fracture and dislocation , pedicle screw rod in-ternal fixation can effectively restore vertebral height and promote injured spinal nerve function .