经伤椎置钉椎弓根螺钉系统固定治疗胸腰椎骨折2年以上随访结果

目的:探讨经伤椎置钉6钉三椎体固定并选择性单节段植骨治疗胸腰椎骨折的临床意义。方法:回顾性分析自2006年1月至2008年12月采用经伤椎置钉6钉三椎体固定方式并选择性单节段植骨治疗且获得2年以上随访的32例胸腰椎骨折患者,其中男25例,女7例,年龄25～60岁,平均39.1岁。按AO分型:A1.3型5例,A3.1型17例,A3.3型8例,C1.1型1例,C1.3型1例。载荷评分4～7分,平均5.8分。脊髓神经损伤按Frankel分级:A级2例,B级2例,C级5例,D级9例,E级14例。测量并对比其术前、术后及最后随访时的Cobb角、椎体前缘高度及椎管占位程度,同时采用Denis评分对疼痛及劳动能力进行评价。结果:32例平均随访时间为39.2个月(30～48个月)。无内固定松动或断裂,除3例为浮壁骨痂外其余病例关节突间及椎板表面植骨融合良好。术后Cobb角、椎体前缘高度及椎管占位情况较术前有明显改善(P<0.05),但最后随访时脊柱矫正度较术后有部分丢失(P>0.05)。25例患者最后随访时CT扫描显示椎体前上方存在大小不一的空洞现象。脊髓神经功能除2例A级无变化外,其余均有1～2级的恢复。Denis疼痛评分:P122例,P27例,P33例。Denis工作状态评分:W118例,W28例,W33例,W53例。结论:虽然经伤椎置钉6钉三椎体固定方式并选择性单节段植骨治疗胸腰椎骨折能有效恢复脊柱生理弧度、伤椎前缘高度及椎管容积,亦无内固定松动或断裂,且腰背痛获得很好缓解,但并不能改善椎体空壳现象,亦不能避免矫正度部分丢失。

Surgical treatment of thoracolumbar fractures using pedicle screws fixation at the level of the fracture:results for following up more than 2 years

Objective: To explore clinical efficacy of thoracolumbar fractures fixation with pedicle screws fixation at the level of the fracture and monosegment bone graft simultaneously. Methods: Retrospective analysis of 32 patients with thoracolumbar fractures underwent surgical procedure of pedicle screws fixation at the level of the fracture and monosegment bone graft simultaneously from January 2006 to December 2008. All the patients were followed up more than two years. There were 25 males and 7 females with an average age of 39.1 years(ranged,25 to 60 years). According to the AO classification,type A1.3 was in 5 cases,type A3.1 in 17,type A3.3 in 8,type C1.1 in 1,and type C1.3 in 1. Load scoring was from 4 to 7 points with average of 5.8 points. The spinal cord function according to Frankel grade,grade A was in 2 cases,grade B in 2,grade C in 5,grade D in 9 and grade E in 14. Cobb angle,the height of anterior border of vertebral body,spinal canal stenosis rate were observed by X-ray films. Meanwhile,pain and work ability were evaluated by Denis scale. Results: All the patients were followed-up from 30 to 48 months(averaged,39.2 months). No internal fixation loosening or breakage were found. Three cases occurred with floating callus and other obtained well bone fusion. Compared with preoperation,Cobb angle,the height of anterior border of vertebral body,and spinal canal stenosis rate improved obviously(P<0.05);but Cobb angle had lost partially at the last follow-up(P>0.05). Meanwhile,anterosuperior part of vertebral body of 25 cases existed cavity phenomenon. The nerve function of all cases recovered for 1-2 grades,except for 2 cases without change whose spinal cord function was degree A preoperatively. According to Denis scale,lower back pain scoring,P1 was in 22 cases,P2 in 7,P3 in 3;state of work scoring,W1 was in 18 cases,W2 in 8,W3 in 3,W5 in 3. Conclusion: It can help to correct the kyphosis and improve low back pain in thoracolumbar fractures through pedicle screws fixation at the level of the fracture and monosegment bone graft simultaneously,but it can not improve the cavity phenomenon of injured vertebral body and avoid partially lost of Cobb angle.