伤椎椎弓根植骨加短节段椎弓根螺钉置入内固定治疗老年人胸腰椎骨折

背景：传统椎弓根内固定系统加后外侧植骨融合治疗老年胸腰椎爆裂性骨折易发生复位角度、高度丢失，迟发性神经损伤，内固定松动。 目的：观察经骨折椎椎弓根植骨联合椎弓根内固定治疗老年胸腰椎爆裂性骨折的方法和效果。 方法：采用经骨折椎椎弓根植骨结合短节段椎弓根螺钉内固定治疗60岁以上老年胸腰椎爆裂性骨折患者32例。评价患者内固定置入前、后及随访时椎体高度、后凸角、椎管内占位，神经功能改变及腰背疼痛等变化。 结果与结论：32例病例均随访6个月以上。无断钉及内固定物松动，椎体高度、后凸角、椎管内占位、神经功能及腰背疼痛明显改善，且椎体高度、后凸角、椎管内占位无明显再丢失。提示经骨折椎椎弓根植骨联合椎弓根内固定，能同时恢复椎体高度及强度，能即时增加椎体的骨容量和脊柱的稳定性，减少内固定因应力过大造成的断钉、断棒、椎体高度丢失等并发症。

Transpedicular bone graft combined with short-segment pedicle screw internal fixation for senile thoracolumbar fracture

BACKGROUND:Traditional pedicle screw internal fixation combined with posterolateral lumbar fusion in the treatment of senile thoracolumbar burst fracture are easily to occur reset angle, high loss, delayed nerve damage and internal fixation loosening. OBJECTIVE:To investigate the method and effect of transpedicular bone graft combined with pedicle screw internal fixation on the treatment of senile thoracolumbar fracture. METHODS:Totally 32 patients who were more than 60 years old with thoracolumbar burst fracture were treated by posterior pedicle fixation combined with grafting through the injured pedicle. Height of fractured vertebrae, Cobb angle, occupying of spinal canal, neuropathic function, lumbar and back pain were measured and analyzed preoperatively, postoperatively and during the follow up period. RESULTS AND CONCLUSION:All the patients were followed-up over 6 months. The internal fixation was not break or loose, the height of fractured vertebrae, the Cobb angle, the occupying of spinal canal, the neuropathic function, lumbar and back pain improved obviously, and the height of fractured vertebrae, the Cobb angle and the occupying of spinal canal were not obviously lose. It is indicated that application of transpedicular bone graft combined with posterior pedicle screw internal fixation is an effective method in treatment of senile thoracolumbar burst fracture, it can restore the height and strength of the vertebral body, and immediately increase vertebral bone content and the stability of the spine, and reduce the possibility of breaking nail, breaking rod, the loss of height and other complications, which are caused by stress.