AO-C1型胸腰椎骨折脱位:可选择4钉2棒置入单节段复位固定

Type AO-C1 thoracolumbar vertebral fracture-dislocations: four-screw two-rod single-segment reduction fixation

背景:AO-C型胸腰椎急性损伤是一种高能量、不稳定性损伤,导致胸腰椎骨折脱位,多伴有脊髓神经损伤,一般均需后路切开复位、减压、植骨融合、椎弓根钉棒系统多节段内固定,致使脊椎运动节段过多丧失、内植物大量应用。目的:探讨后路单节段椎弓根钉棒系统置入对AO-C1型胸腰椎骨折脱位的矫治效果。方法:从2008年1月至2013年12月,对17例AO-C1型胸腰椎骨折脱位患者进行随访。所有患者均一期经后路切开复位、椎弓根钉棒系统内固定,其中8例经脱位椎间隙相邻上下各一椎体4钉2棒单节段固定(4钉2棒组),9例经脱位椎间隙相邻上下椎体行8钉2棒多节段固定(8钉2棒组)。比较两组手术时间、术中出血量;治疗前、治疗后1周及最后随访时,在患者X射线侧位片上测量伤椎后凸Cobb角,采用Frankel分级法进行神经功能评价,采用目测类比评分评估腰背痛程度。结果与结论:随访1-5年。两组手术时间比较差异有显著性意义,4钉2棒组优于8钉2棒组(P<0.05);两组术中出血量比较差异无显著性意义。两组胸腰椎骨折脱位内固定后均明显矫正,腰背痛明显缓解。治疗前脊髓功能为Frankel A级的10例患者末次随访时2例恢复至E级,余8例双下肢瘫痪均未恢复;Frankel B级的2例均恢复至E级。伤椎后凸Cobb角、目测类比评分等指标,治疗后1周、末次随访时与治疗前比较,差异均有显著性意义(P<0.05);而末次随访与治疗后1周比较,差异均无显著性意义;4钉2棒组、8钉2棒组间比较差异均无显著性意义。提示经脱位椎间隙4钉2棒单节段与8钉2棒多节段矫治C1型胸腰椎骨折脱位的疗效无差别。因此AO-C1型胸腰椎骨折脱位可选择4钉2棒置入单节段复位固定。

BACKGROUND： The type AO-C1 thoracolumbar acute spine injury is a kind of high-energy instable injury, can cause thoracolumbar fracture-dislocation, and mainly associated with spinal nerve injury. Generally, all needs to posterior open reduction, decompression, bone graft fusion and multiple-segmental internal fixation of pedicle screw rod system, which causes excessive loss of spinal movement segment and a large number of application of internal fixators. OBJECTIVE： To evaluate the treatment effect of posterior pedicle screw mono-segmental internal fixation for treatment of the type AO-C1 thoracolumbar vertebrae fracture-dislocations. METHODS： From January 2008 to December 2013, 17 cases of type AO-C1 thoracolumbar fracture-dislocation were followed up. All patients were treated with one-stage posterior open reduction and pedicle screw-rod fixation.Of them, eight cases received four screws and two rods for single-segment fixation in upper and lower vertebrae adjacent to intervertebral space after dislocation（4-screw 2-rod group）. Nine cases received eight screws and two rods for multiple-segment fixation in the upper and lower vertebrae adjacent to intervertebral space after dislocation（8-screw 2-rod group）. Operative time and intraoperative blood loss were compared between the two groups. The Cobb＇s angle was measured on lateral X-ray film of two groups preoperatively and 1 week postoperatively and during the final follow-up. The neurological function was evaluated by Frankel classification. The visual analogue scale was adopted to assess the degree of low back pain. RESULTS AND CONCLUSION： Patients were followed up for 1 to 5 years. Significant differences were detected in the operative time between the two groups, and operative time was better in the 4-screw 2-rod group than in the 8-screw 2-rod group（P〈0.05）. No significant difference was found in intraoperative blood loss between the two groups. The deformity of fracture-dislocation had been corrected, and the pain of low back had significantly relieved in all patients after fixation. According to Frankel classification, two cases at Grade A were improved to Grade E, but eight cases at Grade A got no improvement after treatment. Two cases at Grade B were also improved to Grade E at the final follow-up. Significant differences in Cobb＇s angle and visual analogue scale were detectable at 1 week postoperatively and during final follow-up as compared with preoperatively（P〈0.05）, but no significant difference was visible between final follow-up and 1 week postoperatively. No significant difference in Cobb＇s angle and visual analogue scale was observed between the 4-screw 2-rod group and 8-screw 2-rod group. Results indicate that there was no significant difference in the clinical efficacy between 4-screw 2-rod single-segment and 8-screw 2-rod multiple-segment fixation for treating type C1 thoracolumbar vertebrae fracture-dislocation. Therefore, AO-C1 thoracolumbar vertebrae fracture-dislocation could be treated with 4-screw 2-rod single-segment reduction fixation.