原位转棒复位治疗胸腰段单节段压缩骨折

目的:探讨原位转棒复位结合伤椎置钉、短节段固定治疗胸腰段单节段压缩骨折的可行性及临床疗效。方法:2008年12月至2010年5月,收治外伤所致胸腰段压缩骨折患者12例,其中男9例,女3例;年龄24～52岁,平均35.8岁。骨折节段:T112例,T122例,L16例,L22例。所有患者排除骨质疏松症及病理性骨折,无神经损伤症状。收集术前、术后5d、末次随访(至少12个月)时影像资料,对伤椎Cobb角、椎体压缩比例、内固定物状况进行观察。结果:12例患者均获得随访,时间12～30个月,平均19个月。所有病例获得骨性融合,无假关节形成,未见内固定物松动、断裂。矢状面后凸校正Cobb角由术前的(25.8±9.4)°矫正至术后5d的(6.7±2.3)°,末次随访时的(6.9±2.6)°;椎体压缩比例由术前的(42.5±10.4)%恢复至术后5d的(7.5±3.9)%,末次随访时的(8.4±4.5)%;术后5d与术前相比差异有统计学意义(P<0.05),末次随访时与术后5d相比差异无统计学意义(P>0.05)。结论:原位转棒复位结合伤椎置钉、短节段固定操作简便,可使胸腰段单节段压缩骨折获得并保持良好复位,是一种安全有效的治疗方法。

Surgical treatment of thoracolumbar single compression fracture by using in situ rod rotation reduction

Objective:To evaluate the efficacy and clinical outcome of the treatment of thoracolumbar single compression fracture by using in situ rod rotation reduction and short segment pedicle screw at the fracture level. Methods:From December 2008 to May 2010,12 cases of traumatic thoracolumbar single compression fracture(T₁₁-L₂) were treated,including 9 males and 3 females,with an average age of 35.8 years old(ranging from 24 to 52). There were 2 case with T₁₁ fracture,2 cases with T₁₂,6 cases with L₁ and 2 cases with L₂,without osteoporosis,pathological fractures or neurologic deficits. Radiographic data were collected preoperatively,5 days postoperatively and at last follow-up(at least 12 months). Cobb's angle,vetebral compression ratio,internal fixation state were observed. Results:All patients were followed up from 12 to 30 months postoperatively,with an average of 19 months. There was no pseudoarticulation and solid bone fusion was achieved in all cases. There were no complications such as loosening or rupturing of internal fixation and so on. Sagittal kyphotic Cobb angle was corrected from preoperative (25.8±9.4)° to postoperative (6.7±2.3)° and (6.9±2.6)° at last follow-up. The percentage of vertebral compression was corrected from preoperative (42.5±10.4)% to postoperative(7.5±3.9)% and (8.4±4.5)% at last follow-up.There was significant difference between the postoperative data and preoperative data(P < 0.05),while the difference was not significant between the postoperative data and the last follow-up(P > 0.05). Conclusion:The thoracolumbar single compression fracture can obtain and maintain a good restoration by using the technic of in situ rod rotation reduction and short segment pedicle screw at the fracture level. The technique should be highly recommended.