后路短节段固定联合伤椎置钉治疗胸腰椎骨折  

Surgical treatment of thoracolumbar fractures by using the posterior short segment pedicle screw fixation

作　　者：胡力丰[1] 张志成[1] 王晓凯[1] 孙天胜[1] 

机构地区：[1]北京军区总医院全军创伤骨科研究所,100700

出　　处：《中国综合临床》2012年第4期406-408,共3页Clinical Medicine of China

摘　　要：目的观察经伤椎椎弓根置钉复位固定治疗胸腰椎骨折的可行性、适应证及临床疗效。方法我院2007年1月至2010年1月收治的胸腰椎骨折采用经伤椎椎弓根置钉复位固定治疗，共随访32例，对患者术前及术后伤椎高度及伤椎后凸角度（Cobb角）分别进行测定并比较；通过Frankel标准对脊髓神经功能进行评定。结果术后随访12-20个月，所有骨折复位效果满意。手术后伤椎前缘高度比由术前的32．4％-69．3％，平均（51．6±17．8）％恢复到术后2周85．6％-99．2％，平均（92．8：tz6．2）％及末次随访时90．6％-97．8％，平均（93．8±3．6）％。伤椎Cobb角由术前的12．8°-30．5。，平均（20．8±9．1）。恢复到术后2周0°-7．8°，平均（4．9±3．2）°及末次随访时2．0°-12．0°，平均（6．2±4．6）°。伤椎后Cobb角与伤椎前缘高度较术前有明显改善，差异有统计学意义（F值分别为4．520、4．762，P均〈0．01）。脊髓神经功能除3例A级无变化外，其余均有1-2级的恢复。结论对胸腰椎骨折应用伤椎椎弓根螺钉固定有利于矫正后凸畸形和恢复伤椎前缘高度，并且能增加后路短节段内固定系统的稳定性和减少远期矫正度的丢失。Objective To evaluate the efficacy, indications and clinical outcomes of the treatment of thoracolumbar fractures by short segmental pedicle screws fixation at the level of the fracture. Methods Thirty- two patients with thoracolumbar fracture, who underwent surgical procedure of short segmental pedicle screws fixation at the level of the fracture from 2007 to 2010 ,were followed up. X rays were performed preoperatively and postoperatively to locate the injured vertebral segment height and fractured kyphosis vertebral （Cobb angle）. Frankel standard was used to assess the spinal cord function. Results All patients were followed up for 12 to 20 months and were in satisfying condition in the reduction of fracture. After surgery, the height of fractured vertebral body leading edge recovered from preoperative （32.4% ±69. 3% , averaged （51.6 ± 17.8）% ） to （85.6%± 99.2% ,averaged （92. 8 ±6. 2）% ） after two weeks and （90. 6% -97.8% ,averaged （93.8 ±3.6）% ） at the last follow-up. Fractured vertebral Cobb angle was recovered from the preoperative （ 12. 8 °± 30. 5 °, averaged [20.8＋9.1° ） to （0° -7.8 °,averaged [4.9±3.2]°） two weeks later and （2.0°-12.0°,averaged [ 6. 2 ± 4. 6] ° at the last follow-up. Cobb angle of the injured vertebral segment and the extend of vertebral compression were significantly improved after the angle was corrected （ P 〈 0. 01 ）. Conclusion Using reduction and short segment pedicle screw fixation at the fracture level would be helpful to correct kyphotic vertebral compression and restore the height of injured vertebrate, which was also of benefit to increase the stability of short-segment posterior fixation system and reduce the loss of correction in a long run.

关 键 词：脊柱骨折 椎弓根螺钉 伤椎 后路短节段 

分 类 号：R687.3[医药卫生—骨科学]