经骨折椎椎弓根直接复位固定治疗胸腰椎爆裂性骨折  

Treatment of thoracolumbar burst fracture by pedicle screw fixation and direct reduction on fractured vertebrae

作　　者：吴卫平[1] 楼列名[1] 史永振[1] 李振华[1] 顾昕[1] 

机构地区：[1]同济大学附属第十人民医院骨科,上海200072

出　　处：《脊柱外科杂志》2007年第4期206-208,217,共4页Journal of Spinal Surgery

摘　　要：目的探讨胸膜椎爆裂性骨折经骨折椎椎弓根复位固定的可行性。方法2001年6月-2005年11月本院手术治疗了胸膜椎单节段爆裂性骨折患者24例，男16例，女8例；平均年龄为32．5岁。骨折部位：T11 2例，T12 9例，L1 11例，L2 2例。按ASIA脊髓神经功能障碍分级标准：A级1例，B级2例，C级5例，D级3例和E级13例。椎管阻塞面积分为Ⅳ度：阻塞Ⅰ度3例，Ⅱ度9例，Ⅲ度10例，Ⅳ度2例。手术方法：骨折椎及相邻的上、下椎体经椎弓根置钉后，上、下椎弓根钉撑开；按固定区的正常矢状面形态将棒预弯，旋转预弯棒，利用中间螺钉作为支点，将骨折椎向前推顶，纠正伤椎后凸畸形及水平移位。结果伤椎高度恢复至正常的93．6％，水平移位恢复至正常的0．6％，矢状面Cobb角术后恢复至3．1°，椎管面积术后增加至正常的92．1％。骨折椎体愈合满意，不完全神经损伤患者手术后脊髓神经功能有1～2级的恢复。无神经损伤加重等并发症。结论经骨折椎椎弓根螺钉固定对骨折直接复位和固定可提高复位质量，改善固定强度及应力分布，是治疗胸膜椎爆裂性骨折安全可靠的方法。Objective To evaluate the feasibility of the maneuver of pedicle screw fixation and direct reduction on fractured vertebrae. Methods Twenty four cases of one level thoracolumbar burst fracture from June 2001 to November 2005 were reviewed retrospectively. There were 16 males and 8 females, the mean age was 32.5 years old. Of the total fractured vertebraes, 2 cases were in T11 level, 9 in T12, 11 in L1 and 2 in L2. According to the ASIA neurological function grade system, the score of 1,2, 5, 3 and 13 cases were grade A, B, C, D and E respectively. The vertebral canal area occupied by fractured bone were classified into Ⅳ grade, 3 cases were in grade Ⅰ （ 〈1/4）, 9 in grade Ⅱ （1/4 -1/2）, 10 in grade Ⅲ （1/2 - 3/4）and 2 in grade Ⅳ （ 〉 3/4）. Surgical methods： Implanted pedicle-screws in the fractured vertebrae and adjacent vertebraes, set connect rods preformulated according to the thoracolumbar spinal normal curvature on the screws. Then rotated the rods to push the burst vertebrae to correct the kyphosis and dislocation. Results The height of fractured vertebrae were improved from 48.3% preoperation to 93.6% of the normal, the dislocation improved from 17.1% to 0.6%, and the Cobb＇ s angle in sagittal plane improved from 26.5°to 3. 1°after operation, The area of vertebrae canal enlarged from 44.6% to 92.1%, which was improving continuously at foUow-up. No complications occurred postoperatively, while neurological function improved 1 to 2 grades after operation in patients suffered from incomplete neurological injury. Conclusion the maneuver of pedicle screw fixation and direct reduction on fractured vertebrae is a safty and effective therapeutic options to treat the thoracolumbar burst fracture, which is able to improve stabilization and disperse stress.

关 键 词：胸椎 媛椎 脊柱骨折 内固定器 

分 类 号：R683.2[医药卫生—骨科学]