经伤椎椎弓根螺钉固定三椎体治疗胸腰椎骨折疗效观察  

Short-segment Fixation of Thoracolumbar Burst Fractures Using Pedicle Fixation at the Level of the Fracture

作　　者：刘中坡[1] 武玉江[1] 侯市宾[1] 纪江峰[1] 

机构地区：[1]河北省邢台市人民医院脊柱科,054001

出　　处：《中国全科医学》2010年第36期4150-4151,共2页Chinese General Practice

摘　　要：目的探讨经伤椎椎弓根螺钉固定三椎体治疗胸腰椎骨折的可行性和有效性。方法回顾性分析我院2007年6月—2009年4月收治的34例胸腰椎单椎体骨折患者的临床资料,均采用经伤椎5枚或6枚椎弓根螺钉固定三椎体,同时行单节段植骨融合。患者术前、术后即刻和术后12个月随访均行X线及CT检查,测量并比较Cobb角、伤椎前缘压缩率、椎管占位率,同时观察植骨融合及神经恢复情况。结果伤椎置钉均顺利完成,术后无切口感染,未出现神经症状加重现象。所有患者获得12-18个月（平均14.6个月）随访,未出现内固定失败,植骨均获得骨性愈合。术后12个月随访时,Cobb角由术前的12°-42°（26.5°±7.4°）矫正至0°-16°（5.5°±4.8°）,差异有统计学意义（t=13.88,P〈0.05）。伤椎前缘压缩率由术前的20%-50%（70%±12%）恢复至86%-100%（92%±8%）,差异有统计学意义（t=8.89,P〈0.05）。椎管占位率由术前的12%-56%（38%±10%）恢复至0-10%（4%±3%）,差异有统计学意义（t=18.99,P〈0.05）。脊髓神经功能除4例A级无变化,其余均较术前有1-2级恢复。术后12个月随访,脊髓神经功能A级4例,C级3例,D级3例,E级24例。结论经伤椎椎弓根螺钉固定三椎体治疗胸腰椎骨折重建前中后三柱稳定,畸形矫正满意,是治疗胸腰椎骨折的可行而有效的方法。Objective To study the feasibility and clinical therapeutic effect of internal fixation of thoracolumbar fractures with screws through the pedicle of fractured vertebral arch.Methods Clinical data about 34 single level thoracolumbar fracture patients admitted to our department from 2007 to 2009 were retrospectively analyzed.Anterior and posterior margin height of fractured vertebra,Cobb′angle,internal fixation failure,and postoperative complications were compared.Results The patients were followed up for 12~18 months（mean 14.6 months）.the anterior and posterior margin height of fractured vertebra,Cobb′angle,and posterior prominent angle were more significantly improved.Conclusion Internal fixation of thoracolumbar fractures with screws through the pedicle of fractured vertebral arch can achieve better outcome,which is a practical and effective procedure for the fixation of thoracolumbar fractures.

关 键 词：脊柱骨折 骨折固定术 内 胸椎 腰椎 

分 类 号：R683.2[医药卫生—骨科学] R687.32[医药卫生—外科学]