经伤椎椎弓根复位植骨内固定术治疗胸腰椎陈旧性骨折

Transpedicle reduction and bone graft with internal fixation for old thoracolumbar vertebral fractures

目的探讨经伤椎椎弓根复位植骨结合后路内固定术治疗胸腰椎陈旧性骨折的临床疗效。方法选择2013年1月-2014年6月河北省唐山市第二医院脊柱外科28例胸腰椎陈旧性骨折患者（伤后3~5周）。采用经伤椎椎弓根复位加椎体内植骨并后路椎弓根钉内固定治疗。观察术前、术后1周和术后3个月椎体高度压缩率、伤椎Cobb角、ODI评分及椎管侵占率等,并进行比较分析。结果 28例患者均成功实施手术并获随访,时间6~18（10.6±4.8）个月。伤椎高度矫正率约93%,椎体高度压缩率、伤椎Cobb角、ODI评分及椎管侵占率较术前均有明显改善。术前与术后1周及术后3个月比较差异有统计学意义（P〈0.05）;除ODI评分外,术后1个周与术后3个月比较差异无统计学意义（P〉0.05）。无内固定松动、断裂及神经损伤等并发症发生,植骨未吸收。结论经伤椎椎弓根复位加椎体内植骨并后路椎弓根钉内固定对于治疗胸腰椎陈旧性骨折,可增加前柱支撑,减少椎体高度丢失,疗效满意。

Objective To investigate the clinical effects of transpedicle reduction by internal fixation with posterior pedicle screw and bone graft for old thoracolumbar vertebral fractures.Methods Twenty-eight patients were chosen from Jan.2013 to Jun.2014,who had old-fractures of thoracolumbar vertebrae（3-5 weeks after trauma）.All the patients underwent posterior pedicle screw fixation with transpedicular reduction and bone grafting.Vertebral height compression,vertebral Cobb angle,ODI score and vertebra canal compression ratio were reviewed and compared before operation,1 week and 3 months after operation.Results The 28 patients were followed up for 6-18（10.6 ±4.8） months.Radiographic evaluation revealed reduction rate of the injured vertebral height was 93%.Vertebral height compression,vertebral Cobb angle,ODI score and vertebra canal compression ratio were improved.The above data before operation were statistically different from those 1 week and 3 months after operation（P〉0.05）.There were no significant differences between the data 1 week after operation and those 3 months after operation（P〉0.05）,except for ODI.There was no complication such as implant loose,breakage or neurological injury.Conclusions Posterior internal fixation with transpedicle reduction and bone graft for old fractures of thoracolumbar vertebrae can achieve satisfied results in increasing anterior column support and reducing the loss of vertebral height.