手法复位伤椎植骨置钉治疗胸腰椎爆裂骨折

Clinical study of manipulative reduction combined with bone grafting and pedicle screw implanting in injured vertebra for treatment of thoracolumbar burst fracture

目的探讨手法复位结合伤椎植骨置钉治疗胸腰椎爆裂骨折的临床效果。方法所有病例均为单椎体骨折;观察患者术前、术后3d和术后12个月随访时的椎体高度压缩率、Cobb角、内固定并发症情况及神经功能Frankel评级进行比较。结果术后12个月及末次随访两组椎体前后缘高度压缩率,Cobb角比较差异有统计学意义(P<0.01)。观察组疗效优于对照组。末次随访时观察组无内固定并发症发生,对照组出现2例断钉3例螺钉松动退出并后突畸形。结论手法复位结合伤椎植骨置钉治疗胸腰椎爆裂骨折,能够更好的重建并维持伤椎高度及强度,降低内固定失败率,是一种安全、有效的治疗方式。

Objective To investigate the curative effect of thoracolumbar burst fracture with manipulative reduction combined with bone grafting and pedicle screw implanting in injured vertebra. Methods All cases are single- vertebral fractures. In the preoperative,postoperative 3D and 12 months after surg- ery,All of the patients were followed up to compare Compression rate of anterior and posterior margin of vertebral body,Cobb angle,internal fixation complications and neurological function Frankel classification. Results At 12 months after surgery,Compression rate of anterior and posterior margin of vertebral body and Cobb angle of the two groups were statistically significant（ P〈0. 01）. The effect of observation group was better than that of control group. At the end of the follow- up,no internal fixation complications occurred in the observation group. In the control group,there were 2 cases of broken screws,3 cases of screw loosening and Posterior deformity. Conclusion Treatment of thoracolumbar burst fractures with manipulative reduction combined with bone grafting and pedicle screw implanting in injured vertebra has satisfactory effectiveness. It can be used to reconstruct and maintain the vertebral height and strength,reduce the failure rate of internal fixation.