经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折  

Treatment of thoracolumbar burst fractures by percutaneous pedicle screw internal fixation

作　　者：赵红卫[1] 刘扬[1] 张思胜[1] 刘万军[1] 肖运祥[1] 邹戟[1] 肖齐三[1] 

机构地区：[1]三峡大学第一临床医学院宜昌市中心人民医院骨科,湖北宜昌430030

出　　处：《上海医学》2012年第7期605-608,I0001,共5页Shanghai Medical Journal

摘　　要：目的探讨使用单向长尾椎弓根螺钉行经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折的可行性及疗效。方法选择26例伤后1周内无明显脊髓神经损伤的Altas A、B、C型胸腰椎爆裂性骨折患者,使用单向长尾椎弓根螺钉行经皮椎弓根螺钉内固定,并经椎弓根行伤椎植骨。手术前、后通过X线片及CT扫描测量伤椎前缘高度、Cobb角及椎管矢状径,并进行比较。术后12个月复查X线片,比较伤椎前缘高度及Cobb角的变化。结果 26例患者均顺利完成手术,术后1周复查X线片和CT扫描,伤椎椎体前缘高度、Cobb角及椎管矢状径分别为(95.1±4.7)%、(3.2±2.3)°及(89.7±6.5)%,与术前的(57.5±11.9)%、(14.7±5.9)°及(67.8±10.3)%比较,差异均有统计学意义(P值均<0.01)。11例患者于术后12个月复查X线片,椎体前缘高度、Cobb角分别为(94.7±4.4)%、(4.0±3.1)°,与术后1周比较,差异均无统计学意义(P值均>0.05)。椎管侵占率由术前的(32.2±10.3)%降至术后的(10.3±6.5)%,差异有统计学意义(P<0.01)。不同部位及不同类型骨折术后的椎体前缘高度改善率、Cobb角改善率及椎管矢状径改善率的差异均无统计学意义(P值均>0.05)。结论对Altas A、B、C型胸腰椎爆裂性骨折采用单向长尾椎弓根螺钉行经皮椎弓根螺钉内固定的手术安全可靠,疗效满意,但操作技术要求高,应严格掌握手术适应证。Objective To investigate the feasibility and clinical outcomes of percutaneous pedicle screw internal fixation for treatment of thoracolumbar burst fractures with single axial screw. Methods Twenty-six patients with thoracolumbar burst fractures （Type A, B or C of Altas）, who had no severe spinal and neurological deficits within one week after injury, were treated with single axial screw internal fixation and transpedicular bone grafting. Anterior height of injuried vertebrae, Cobb angle and sagittal diameter of vertebral canal were measured by X-ray and CT scan before and after operation. Anterior height of injuried vertebrae and Cobb angle were rechecked by X-ray 12 months postoperatively. Results The operations were successfully completed in all the 26 patients. Anterior height of the injuried vertebrae, Cobb angle and sagittal diameter of spinal canal were measured by X-ray and CT scan one week postoperatively. There were significant improvement in anterior height （[95.1 ± 4.7]% vs. [57.5±11.9]%）, Cobb angle（3.2°±2.3°vs. 14.7°±5.9°） and sagittaldiameter （[89.7±6.5]% vs. [67.8± 10.3]% ） as compared with preoperative ones （P〈0.01）. Anterior height of the injuried vertebrae and Cobb angle of 11 cases were （94.7±4.4） % and 4.0° ± 3. 1° at 12 months after operation. There was no significant difference in terms of anterior height and Cobb angle one week and 12 months postoperatively （P〉 0.05）. The rate of spinal canal invasion reduced from （32. 2±10. 3）% preoperatively to （10. 3 ± 6. 5）% postoperatively （P〈0.01）. The improvement rates of anterior height of the injuried vertebrae, Cobb angle and sagittal diameter of spinal canal were not statistically significant between different types and different positions of fractures （P〉0.05）. Conclusion Percutaneous pedicle screw internal fixation using single axial screw is afeasible and safe treatment for thoracolumbar burst fractures （Type A, B or C of Altas）. But indications should be selected strictl

关 键 词：爆裂性骨折 胸腰椎 经皮 椎弓根螺钉内固定 

分 类 号：R687.3[医药卫生—骨科学]