椎弓根螺钉内固定治疗胸椎骨折合并脊髓损伤的临床疗效分析

Analysis of clinical curative effect on thoracic vertebral fracture with spinal cord injury treated with pedicle screw fixation

目的：观察椎弓根螺钉内固定治疗胸椎骨折合并脊髓损伤的临床疗效及安全性.方法：2010年4月~2014年6月,采用椎弓根螺钉内固定治疗胸椎骨折合并脊髓损伤21例,手术前后测量伤椎Cobb 角及椎体前缘高度,根据Frankel分级评定神经功能愈合情况.结果：21例患者中19例获得随访,平均随访时间28±4.7个月.病椎前柱高度由手术前平均48.9%±10.4%恢复至手术后的86.8%±15.3%,结果具有统计学差异（P〈0.05）.Cobb角由术前平均18.6±1.9到最后随访时的5.9±0.4,结果具有统计学差异（P〈0.05）.最后随访时脊髓神经功能有显著改善：4例Frankel A级患者改善不明显;7例Frankel B级患者中,有5例恢复到C级,2例恢复到D级;5例Frankel C级患者中,有3例恢复到D级,有2例恢复到E级;3例Frankel D级患者术后均恢复到E级.最后随访时所有患者伤椎均达到骨性愈合,无内固定松动及断裂.结论：椎弓根螺钉内固定治疗胸椎骨折合并脊髓损伤临床疗效肯定.在保证进针点及进针方向准确的前提下,经椎弓根螺钉内固定在胸椎骨折合并脊髓损伤中的应用是安全有效的.

Objective： ： To observe the clinical efficacy and safety of on thoracic vertebral fracture with spinal cord injury treated with pedicle screw fixation. Methods： From April 2010 to June 2014, the pedicle screw fixation was used in the treatment of thoracic vertebral fracture with spinal cord injury in 21 cases. Cobb angle and the pre and postoperative anterior vertebral height was measured, and the Frankel classification neural function recovery was observed. Results： 19 cases were followed up in 21 cases, the mean follow up time was 28 ±4.7 months. The anterir vertebral height got improved from （48.9% ± 10.4% ） preoperatively to （86.8 %± 15.3 % ） postoperative- ly. Cobb angle recovered from preoperative （18.6± 1.9） to （5.9±0.4） at follow up. The Frankel spinal nerve function improvement at the end of the follow up showed 4 patients have no significant improvement of grade A, 5 recovered to grade C and 2 cases to grade D in 7 cases of grade B, 3 recovered to grade D and 2 to grade E in 5 patients of grade C and the other 3 cases of grade D all recovered to grade E. At the last time of follow up, all fractures had bone fusioned, no internal fixation loose or collapse was observed. Conclusion： The pedicle screw fixation could get confirm clinical effect and obtain satisfactory reduction in the treatment of thoracic vertebral fracture with spinal cord injury. With the correct choice of the point and the direction of the needling, it might be safe of the internal fixation of pedicle screw fixation for the treatment of thoracic vertebral fracture with spinal cord injury.