短节段伤椎单侧置钉对侧经椎弓根植骨治疗不稳定型胸腰椎骨折

Treatment of Unstable Thoracolumbar Vertebral Fractures with Posterior Short Segmental Pedicle Screw Fixation and Transpedical Bone Grafting

目的探讨后路短节段联合伤椎单侧置钉对侧经椎弓根植骨治疗不稳定型胸腰椎骨折的临床疗效。方法2013年1月至2016年1月采用后路短节段联合伤椎单侧置钉对侧经椎弓根植骨治疗不稳定型胸腰椎骨折,获得随访25例,设定为观察组;同时回顾性分析2012年12月以前,手术治疗胸腰椎不稳定型骨折,获得完整随访资料者25例,手术方式均为后路长节段跨伤椎8钉内固定联合椎板横突间植骨术,设定为对照组。两组病例均为AO分型中的A3型,单一椎体骨折。比较两组术前、术后腰背痛VAS评分,伤椎前缘高度比、矢状位Cobb角、神经功能和伤椎椎体内空壳现象的发生率。结果两组病例随访12～16个月,平均(14.5±2.9)个月。两组组内术后的伤椎前缘高度比、矢状位Cobb角、神经功能较术前均有显著改善,差异具有统计学意义(P<0.05)。但两组间比较差异无统计学意义(P>0.05)。实验组伤椎椎体内空壳现象的发生率小于对照组,差异具有统计学意义(P<0.05)。实验组无断钉、断棒的发生,而对照组有一例在术后1年发生断棒现象。结论后路短节段联合伤椎单侧置钉对侧经椎弓根植骨治疗不稳定型胸腰椎骨折安全有效,同时可有效恢复伤椎前柱高度,促进伤椎椎体一期愈合,减少伤椎内空壳现象的发生,重建脊柱的力学稳定性。

Objective To investigate the clinical effect of posterior short segmental pedicle screw fixation combined with transpedical bone grafting in the treatment of unstable thoracolumbar vertebral fracture.Methods From January 2013 to January 2016,25 cases of unstable thoracolumbarvertebral fractures were treated with posterior short segmental pedicle screw fixation combined with transpedical bone grafting.This group was set up for the observation group.Another 25 unstable thoracolumbarvertebral fractures cases were retrospectively analyzed prior to December 2012.In those cases,which was set up for control group,the operation method was posterior long segmental(8 transpedical screw)fixation crossing the injured vertebrae.Both groups of patients were type A3 in AO classification and single vertebral body fracture.The VAS score of lumbar back pain,the ratio of the anterior edge height of the injured vertebra,the sagittal Cobb Angle,the nerve function before and after the operation and the incidence rate of empty shell in the injured vertebra were compared statistically between the two groups.Results The two groups were followed up for 12~16(14.5±2.9)month.There were significant improvements in the anterior edge height of the injured vertebra,the sagittal Cobb Angle and the nerve function in both groups after surgery,and the difference was statistically significant(P<0.05).However,there was no statistically significant difference between the two groups(P>0.05).The incidence rate of hollow shell in the injured vertebral body in the experimental group was smaller than that in the control group,and the difference was statistically significant(P<0.05).There was no pedicle screw or rod breaking in the experimental group,but one case suffered rod breakage in the control group one year after surgery.Conclusion It is safe and effective to treat unstable thoracolumbar vertebral fractures with posterior short segmental pedicle screw fixation combined with transpedical bone grafting.Meanwhile,it can effectively restore the height of injured vertebral column,promote the primary healing of injured vertebral body,reduce the occurrence of empty shell in injured vertebral body and rebuild the mechanical stability of spine.