经伤椎单侧固定治疗后纵韧带完整的胸腰椎骨折的临床疗效分析

CLINICAL EFFECTIVENESS OF INTERMEDIATE UNILATERAL PEDICLE SCREW FIXATION FOR THORACOLUMBAR FRACTURES WITH INTACT POSTERIOR LONGITUDINAL LIGAMENT

目的探讨经后路短节段伤椎单侧5钉固定治疗后纵韧带完整的胸腰椎骨折的临床疗效。方法:2013年1月~2018年5月,采用后路短节段经伤椎单侧5钉固定治疗后纵韧带完整的胸腰椎单一椎体骨折,共30例,所有伴有神经损伤的患者均行椎管潜行减压手术。通过观察患者手术前后的伤椎前缘高度比、Cobb角、Frankel分级及术后脊柱侧方成角的变化,从而评价经伤椎单侧固定的临床疗效。结果所有患者均获得随访,时间为11~20个月,平均14.5个月。术后均无内固定松动、断裂等并发症的发生。患者术后即刻伤椎高度及Cobb角较术前明显改善,具有统计学差异(P <0.05);末次随访时伤椎高度、脊柱侧方成角和Cobb角较术后即刻均有所丢失,但前后比较无明显统计学差异(P<0.05);末次随访时,Frankel分级为B级的恢复到C级,其余C级、D级的均恢复到E级,差异具有统计学意义(P <0.05);结论经伤椎单侧5钉固定治疗后纵韧带完整的胸腰椎骨折,临床疗效满意。对于伴有神经损伤的患者,可以行潜行减压手术,神经症状恢复满意;对于无神经损伤的患者,只要后纵韧带保持完整,无论椎管内骨折块占位多少,均无需行减压手术。

Objective: To discuss the clinical efficacy of intermediate unilateral pediclescrew fixation for thoracolumbar fractures with intact posterior longitudinal ligament. Methods: 30 cases of single thoracolumbar fractures with intact posterior longitudinal ligament were selected and treated with intermediate unilateral pedicle screw fixation in the hospital between January 2013 and May 2018. All patients with neurological symptoms underwent spinal canal decompression surgery by undermining decompress. The efficacy was assessed by the changes of the fractured vertebrae height, Cobb angle, lateral angle and the Frankel grading pre-and post-operation. Results: All the patients were followed up from 11 to 20 months with an average of 14.5 months. No complications such as loosening of internal fixation and fracture occurred after operation. The Cobb angle and the fractured vertebrae height at immediate after operation were significantly improved compared with preoperative values(P < 0.05). But there was no significant difference about the correction of the fractured vertebrae height, Cobb angle and lateral angle between the immediate after operation and the final follow-up(P > 0.05). The Frankel grades were improved from B to C, from C, D to E at last follow-up with significant difference compared with preoperative grades(P < 0.05). Conclusion: The clinical efficacy of unilateral 5 screw fixation for thoracolumbar fracture with intact posterior longitudinal ligament is satisfactory. For the patients with neurological symptoms, it is not required with total laminar decompression surgery which can be performed by undermining decompress, and neurological symptoms can recovered satisfactorily. For the patients without neurological symptoms, no decompression surgery is required regardless of the number of spinal canal compromise.