经后路伤椎置钉结合功能锻炼治疗胸腰椎骨折临床观察

Clinical Observation on Effect of Posterior Pedicle Screw Placement Via the Injured Vertebra Combined with Functional Exercise for the Treatment of Thoracolumbar Fracture

目的：探讨经伤椎椎弓根钉内固定结合术后功能锻炼治疗胸腰椎骨折的方法及效果。方法 ：短节段经伤椎治疗胸腰椎骨折患者78例,72例获得随访,术后对伤椎前缘高度、伤椎Cobb角、椎管容积、腰背痛及神经功能恢复等方面进行评价。结果：获得随访的患者术后伤椎前缘高度恢复至（95.2±3.5）%,脊柱Cobb角恢复至术后的（4.5±3.2）°,伤椎平均正中矢状径恢复至术后的（96.5±2.3）%,手术前后有显著性差异（P〈0.05）。患者腰背痛症状明显缓解,VAS评分由术前的（9.4±0.6）分降到术后的（2.4±2.7）分。神经功能除术前4例A级的患者下肢感觉、运动无改善,剩下患者神经功能均有1-3级的恢复;术后随访出现1例患者椎弓根螺钉断裂现象。结论：经伤椎椎弓根钉内固定术对骨折复位满意,重建脊柱的稳定性,术后功能锻炼对腰背痛及术后神经功能恢复起到促进作用,减少术后并发症。

Objective： To investigate the effect of vertebral pedicle screw fixation via the injured vertebra combined with postoperative functional exercise for the treatment of thoracolumbar fractures. Method： 72 Patients out of 78 thoracolumbar fracture patients treated via the short segmental injured vertebra were followed. ARer surgery and during follow-up, the anterior heights of injured vertebra and Cobb＇s angle, the spine canal middle diameter of these patients were evaluated with X-ray and CT, the symptoms of back pain and neuro-functionsl recovery of the spinal cord were also evaluated. Result： After a median 18 months （6 to 36 months） follow up, anterior heights of injured vertebra was （95.2± 3.5）%, Cobb＇s angle of the spine reached （4.5 ± 3.2）° , and the spine canal middle diameter was （96.5± 2.3）%, there were significant differences before and after operation （P〈0.05）. Patients＇ symptoms of back pain were relieved, VAS score was reduced from （9.4± 0.6） to （2.4±2.7） after the operation. 68 Patients＇ neuro-functional recovery of the spinal cord was improved by 1-3 grade except that the sensation and perception in lower limb of 4 cases with neurolosic function. Grade A before operation were no improvement. One patient＇s pedicle screw was broken. Conclusion： Vertebral pedicle screw fixation with postoperative function exercise can not only have satisfactory fracture reduction and increase the stability of spine, but also can relieve backache symptoms, improve neuro-functional recovery of the spinal cord, and reduce the postoperative complications.