伤椎单侧置钉短节段固定术治疗无脊髓损伤的胸腰椎爆裂骨折

Short segmental pedicle instrumentation combind with fracture-level unilateral fixation for thoracolumbar burst fracture without spinal cord injury

目的：探讨经后路伤椎单侧置钉结合短节段固定术治疗无脊髓损伤胸腰椎爆裂骨折的临床效果。方法：对58例无脊髓损伤的胸腰椎爆裂骨折患者行后路伤椎单侧置钉结合短节段固定术治疗。术后随访12~36个月,平均22.7个月,对患者术前、术后3 d及术后1年脊柱矢面后凸Cobb角、伤椎压缩率进行测量并比较。结果：所有患者骨折均获得骨性愈合,X线片显示内固定物无松动及断裂,伤椎高度恢复良好,无脊柱后凸畸形。术后3 d、1年与术前比较,Cobb角、伤椎压缩率差异均有统计学意义（P〈0.05）,术后3 d与术后1年的Cobb角、伤椎压缩率比较,差异无统计学意义（P〉0.05）。结论：伤椎单侧置钉结合短节段钉棒系统可有效地进行伤椎固定,并很好地恢复脊柱的正常序列及伤椎高度。

Objective： To explore the clinical efficacy of short segmental pedicle instrumentation with fracturelevel unilateral fixation for thoracolumbar burst fracture without spinal cord injury. Methods： Fifty-eight cases of thoracolumbar burst fracture without spinal cord injury were treated with short segmental pedicle instrumentation combined with fracture-level unilateral fixation. All patients were followed up for an average of 22. 7（ 12 to 36）months. The Cobb angle of the injured vertebrae and compression rate were measured and compared before surgery,at three days and one year after surgery. Results： All cases achieved bone fusion and without implant failure. The height of fractured vertebrae recovered well without kyphosis. Between pre-operation and three days or 1 year after surgery,there were statistically differences in the Cobb angle of the injured vertebrae and compression rate（ all P〈0. 05）. There were no significant differences between three days and 1 year after surgery（ P〉0. 05）. Conclusions：Short segmental pedicle instrumentation combined with fracture-level unilateral fixation is an effective treatment for fixation of thoracolumbar burst fracture,it can restore the normal sequence of spine and the height of fractured vertebrae effectively.