新型板棒复合固定系统前路单节段固定治疗DenisB型胸腰椎爆裂性骨折

Anterior single-segmental decompression and fixation with a noval rod-screw construct for Denis type B burst fractures

目的评估一种新型脊柱板棒复合系统用于DenisB型胸腰椎爆裂性骨折进行前路单节段融合的疗效。方法对2007年2月至2010年5月收治的28例DenisB型胸腰椎爆裂性骨折患者资料进行回顾性分析，男18例，女10例；年龄18～52岁，平均37．4岁；骨折部位：T11 3例，T12 10例，L-12例，L23例，其中7例伴有单侧椎弓根骨折，3例伴双侧椎弓根骨折。所有患者神经功能损伤按照美国脊髓损伤协会分级：B级11例，c级9例，D级8例；行前路单节段减压，钛笼加自体骨移植，新型板棒复合系统固定。术后通过患者视觉模拟评分（VAS）、cobb角及椎管内骨块占位比例观察疗效。结果所有患者术后获平均26个月（17—33个月）随访，平均手术时间为144min（90～176min），平均失血量为580mL（300—1100mL）。所有患者的VAS、cobb角及椎管内骨块占位比例由术前的（8．2±1．5）分、17．4°±4．3°、53％4-16％改善为末次随访时的（2．7±2．4）分、9．4°±5．8°、4±2％，差异均有统计学意义（P〈0．05）。无患者出现神经功能恶化。结论新型板棒复合系统在前路单节段融合术中是一项安全、有效的固定系统，可以用于DenisB型胸腰椎爆裂性骨折的治疗。

Objective To evaluate our noval rod-screw construct in anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures. Methods From February 2007 through May 2010, we treated 28 patients with Denis type B burst fracture. They were aged from 18 to 52 years （average, 37.4 years）. The fractures were located at Tll in 3 cases, at T12 in 10, L1 in 12, and L2 in 3. Of them, 7 were complicated with unilateral pedicle fracture and 3 with bilateral pedicle fractures. According to the American Spinal Injury Association （ASIA） scale, the neurological deficits were rated as grade B in 11 cases, as grade C in 9, and grade B in 8. All the patients received anterior single-segmental decompression, titanium mesh and autogenous bone graft, and fixation with our noval rod-screw construct. The therapeutic efficacy was evaluated in terms of visual analogue scale （VAS）, cobb angle, and spinal canal encroachment. Results The mean follow-up time was 26 months （range, from 17 to 33 months） . The average length of surgery was 144 minutes（range, from 90 to 176 min）; the mean blood loss was 580 mL （range, from 300 to 1 100 mL）. The mean VAS score, cobb angle and spinal canal encroachment were im- proved from 8.2 ± 1.5, 17.4°± 4. 3° and 53% ± 16% preoperatively to 2. 7 °± 2. 4°, 9.4°±5.8° and 4% ± 2% at the final follow-up, respectively（ P 〈 0. 05）. None of the patients exhibited neurological deterioration. Conclusion Our noval rod-screw construct is a safe and effective device that can be used in the anterior single-segmental decompression and fixation for the treatment of Denis type B burst fractures.