经伤椎翘拨复位植骨内固定治疗胸腰椎爆裂性骨折的临床效果观察

Clinical efficacy of poking reduction,bone grafting and pedicle screw implanting through injured vertebra in treatment of thoracolumbar burst fracture

目的评价经伤椎翘拨复位植骨、椎弓根螺钉内固定治疗胸腰椎爆裂性骨折的临床效果。方法 2013年1月-2013年12月共57例胸腰椎爆裂性骨折患者在成都军区总医院行经伤椎翘拨复位植骨、椎弓根螺钉内固定术,记录和观察患者围术期基本情况及并发症,记录术前、术后1周和末次随访时患者的疼痛视觉模拟评分（VAS）及神经功能情况（ASIA分级）,测量术前、术后1周和末次随访时的伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率和Cobb角并进行统计学分析。结果 57例患者均顺利完成手术,手术时间70～120min,出血量120～280ml,术中无脊髓、神经损伤,无硬膜撕裂。所有患者均获随访,随访时间12～36个月,患者神经功能较术前有明显恢复。末次随访X线片及CT示椎体骨折均愈合,内固定位置良好,未见明显松动迹象。术后1周和末次随访时的VAS、伤椎前缘压缩率、伤椎后缘压缩率、椎管狭窄率、Cobb角与术前相比差异均有统计学意义（P〈0.05）,而术后1周与末次随访时比较差异均无统计学意义（P〉0.05）。结论经伤椎翘拨复位植骨、椎弓根螺钉内固定可以有效地恢复伤椎的高度和减轻椎管内压迫,有利于后凸畸形的矫正和脊髄功能的恢复。该方法可以很好地维持伤椎高度,显著降低了远期椎体塌陷的风险。

Objective To evaluate the clinical efficacy of poking reduction, bone grafting and pedicle screw implanting through injured vertebra in treatment of thoracolumbar burst fracture. Methods Fifty-seven patients with thoracolumbar burst fractures between January 2013 and December 2013 were treated in Chengdu Military General Hospital by poking reduction, bone grafting and pedicle screw implanting through injured vertebra. All the patients were observed and recorded for basic conditions and complications. At pre-operation, 1 week post-operation and last follow-up, pain visual analogue scale （VAS） and neurological function score （ASIA） were recorded and the compression ratio of anterior edge and posterior edge of fractured vertebra, compression ratio of spinal canal and Cobb angle were measured and statistically analyzed in all the patients. Results M1 the patients acquired surgical success with operation time about 70-120min and blood loss about 120-280ml. There was no spinal cord or nerve injury and no dural tear during the surgery. M1 the patients were followed up for 12 to 36 months and the neurological function significantly recovered. X-ray and CT examination at last follow-up showed good fracture healing, good position and no loosening of internal fixation device. At 1 week post-operation and last follow-up, VAS, compression ratio of anterior edge and posterior edge of fractured vertebra, compression ratio of spinal canal and Cobb angle were significantly lower than those at pre-operation （P〈0.05）, but there were no significant differences in these parameters between 1 week post-operation and last follow-up （P〉O.05）. Conclusions Poking reduction, bone grafting and pedicle screw implanting through injured vertebra can effectively restore height of injured vertebra and reduce the compression of spinal canal, which will help correction of spinal kyphosis and recovery of spinal cord function. This method can well maintain height of injured vertebra and significantly reduce risk of long-term vertebral collapse.