伤椎椎体内植骨椎弓根钉棒内固定治疗胸腰椎骨折疗效

Treatment of Thoracolumbar Fracture With Internal Fixation of Vertebral Body and Pedicle Screw Rod in Vertebral Body

目的研究分析经后方肌间隙入路病椎椎体内植骨椎弓根钉棒系统内固定治疗胸腰椎骨折疗效。方法选取本院2009年2月—2017年1月收治的胸腰椎骨折患者146例,全部患者均采取经后方肌间隙入路病椎椎体内植骨椎弓根钉棒系统内固定治疗,持续随访观察10个月评估疗效。结果手术时间(133.52±27.38)min,术中出血(163.25±41.3)ml。患者术后未见切口感染现象,无脊髓神经损伤或脑脊液漏等症状。患者椎体前柱高度均恢复效果达到(98.5±0.7)%;后凸Cobb角恢复-7.7°;椎管占位改善至2.3%。141例患者椎管得到完全减压,仅5例患者椎管侧残留有微小骨块。经持续随访10个月~3年以上发现,内植骨融合效果良好,椎管恢复完整性。无骨折复位失效或松脱,未见假关节,椎弓根内固定螺钉均完好,无松动、弯曲。ASIA2000脊髓损伤神经功能评定标准中发现,146例患者神经功能均改善1~3级,2例恢复至C级,17例恢复至D级,127例恢复至E级。结论胸腰椎骨折患者经后方肌间隙入路病椎椎体内植骨椎弓根钉棒系统内固定治疗效果良好,可降低伤椎旁肌损伤,减少患者手术风险,保证椎体肌肉的完整,提高患者术后恢复效果。

Objective To study the effect of internal fxation of vertebral pedicle screw rod and rod system in the treatment of thoracolumbar fracture with posterior intermuscular interspace approach. Methods 146 patients with thoracolumbar fractures treated from February 2009 to January 2017 in our hospital were selected, they were treated with the internal fxation of the vertebral pedicle screw rod system of the vertebral body with the posterior intermuscular interspace approach, and the curative effect was evaluated for 10 months. Results The operation time was （133.52±27.38） min, and the bleeding was （163.25±41.3） ml during the operation, there was no infection of incision after operation, no spinal cord nerve injury or cerebrospinal fuid leakage. The recovery effect of the anterior column height of the patients reached to （98.5±0.7）%, and the kyphosis Cobb angle recovered to -7.7°, and the vertebral canal occupying position was improved to 2.3%. The spinal canal was completely decompressed in 141 cases, and only 5 patients had small bone fragments in the spinal canal. After 10 months to 3 years of continuous follow-up, it was found that the fusion effect of the internal bone graft was good and the spinal canal recovered integrity. No fracture reduction or loosening, no false joint, pedicle internal fxation screws were all well, no loosening, bending. ASIA2000 neurological function evaluation criteria for spinal cord injury found that 146 patients had improved neurological function level 1 to 3, 2 cases recovered to C level, 17 cases recovered to D level, 127 cases recovered to E level. Conclusion Through thoracolumbar fracture, posterior intermuscular space approach, vertebral pedicle screw internal fixation is effective, which can reduce injury of paraspinal muscles, reduce operative risk, guarantee vertebral body integrity and improve postoperative recovery.