短节段椎弓根螺钉系统治疗胸腰段脊柱骨折-脱位

Thoracolumbar spinal fracture-dislocation treated with short-segment pedicle instrument

目的探讨后路短节段椎弓根螺钉系统治疗胸腰段脊柱骨折-脱位的效果。方法 25例患者均于全身麻醉下行后路椎板减压、复位,短节段椎弓根螺钉内固定,自体骨植骨治疗。所有病例随访8个月~4年,平均22个月。比较手术前后伤椎前、后缘椎体的高度,Cobb角,椎管横截面积与神经功能,评价疗效。结果脊柱序列基本恢复正常。伤椎平均前后缘高度分别是：术前（17.2±2.1）mm、（28.8±2.2）mm,术后（30.5±2.5）mm、（31.6±2.7）mm;Cobb角：术前32.5°±4.5°,术后7.6°±2.2°;椎管截面积术前平均36.5%±4.6%,术后86.4%±3.5%,各项指标与术前相比有显著差异（P〈0.01）。神经功能恢复情况：2例完全截瘫无恢复,余按Frankel分级有1~3级恢复。结论短节段椎弓根内固定具有手术操作简单安全、固定节段少、重建脊柱序列等优点,植骨能明显改善伤椎骨折的愈合,维持椎体的高度,减少断钉等情况的发生。适用于胸腰椎骨折-脱位的治疗。

Objective To study the efficacy of short-segment pedicle instrument in treatment of thoracolumbar spinal fracture-dislocation. Methods Under general anaesthesia, 25 cases were treated by posterior route reduction and laminectomy, short-segment pedicle screw internal fixation and implantation of autogenous bone. All cases were followed up for 8 months to 4 years, with an average of 22 mouths. The anterior and posterior height of fractured vertebrae, Cobb angle, cross-section area of spinal canal and nerve function were compared before operation and after aperation. Results Spinal alinement resumed normal status. The average anterior and posterior height of fractured vertebrae was （17.2±2.1） mm and （28.8±2.2） mm before operation, and （30.5±2.5） mm and （31.6±2.7） mm after operation. The Cobb angle was 32.5°±4.5° before operation, and 7.6°±2.2° after operation. The cross-section area of spinal canal was 36.5%±4.6% before operation, and 86.4% ± 3.5% after operation. There were significant differences between preoperative indices and postoperative indices （P〈0.01）. As to nerve recovery, 2 cases of complete paraplegia did not recover, and the others recovered 1 to 3 grades by Frankel. Conclusion Short-segment pedicle instrument is suitable for treating thoracolumbar spinal fracture-dislocation, which has advantages of simplicity and safety, with less segment fixed and reduced spinal alinement.