后路经伤椎椎弓根螺钉结合短节段椎弓根螺钉系统内固定治疗胸腰椎爆裂型骨折

目的：探讨后路经伤椎椎弓根螺钉结合短节段椎弓根螺钉系统内固定治疗胸腰椎爆裂型骨折的临床疗效。方法：2006年6月至2009年2月对37例胸腰椎爆裂性骨折患者采用短节段椎弓根螺钉系统同时经伤椎椎弓根内固定治疗。所有患者术前、术后、随访均行X线检查,测量伤椎椎体前缘高度值、Cobb’s角,术前CT和术中3D-CT测量椎管骨折块占位比。观察术后并发症和脊髓神经功能恢复情况。结果：患者随访6个月至30个月,平均16.5±7.8个月。伤椎均顺利完成椎弓根螺钉植入,螺钉位置及稳定性良好。无切口感染,无脊髓神经症状加重,无内固定松动及断裂现象。伤椎前缘高度恢复满意,术后、末次随访（87.13±8.36）%、（85.91±9.42）%均较术前（47.78±13.56）%明显恢复（P〈0.05）。伤椎Cobb’s角术后、末次随访（6.74±4.78）°（、7.45±5.04）°均较术前（28.96±5.48）°减少（P〈0,05）。术中3D-CT测量椎管内骨块占位比为（7.38±2.11）%较术前（35.23±18.63）%减少（P〈0.05）。脊髓神经功能较术前均有1级至2级的恢复。结论：后路经伤椎椎弓根螺钉结合短节段椎弓根螺钉内固定治疗胸腰椎骨折可增加骨折固定稳定性,有效恢复和维持伤椎高度,矫正后凸畸形,获得满意临床疗效。

Posterior short-segment pedicle screw via the injured vertebra for treatment of thoracolumbar burst fractures

Objective：To explore the clinical efficacy of posterior short-segment pedicle screw via the injured vertebra for thoracolumbar burst fractures treatment.Methods：A total of 37 patients of thoracolumbar burst fracture were treated with posterior short-segment pedicle screw via the injured vertebra from June 2006 to February 2009.Preoperative,toperative and follow-up.All the patients were evaluated with X-ray for anterior vertebral heights of the injured and Cobb＇s angle.Preoperative CT scans and intraoperative 3D-CT were used to measure the sagittal canal diameter（SCD）.We also observed the Postoperative complications and neurofunctional recovery of the spinal cord.Results：All cases were followed up 6-30 months,average 16.5±7.8 months.Screw insertion was successful in every injured vertebral body and all of screws of injured vertebral body were stable.There was no infection of incision and no aggravation of spinal cord function,there was no implant failure.Anterior vertebral heights of the injured showed good recovery,mean anterior vertebral heights of the injured post-operatively and follow-up were（87.13±8.36）% and（85.91±9.42）%,with statistical difference compared with the preoperative（47.78±13.56）%（P0.05）,Cobb＇s angle post-operatively and follow-up were（6.74±4.78）°and（7.45±5.04）°,with statistical difference compared with the preoperative（23.95±5.48）（P〈0.05）.The sagittal canal diameter pre-and intraoperatively was（7.38±2.11）% and（35.23±18.63）%,with statistical difference（P〈0.05）.In patients with incomplete injuery,neuralfunctions showed 1 to 2 grade improvement compared with the findings before operation.Conclusion：Posterior short-segment pedicle screw via the injured vertebra can help correct the kyphosis and maintain the reduction enhance the stiffness of Posterior short-segment instrumentation in thoracolumbar burst fractures.