短节段椎弓根螺钉置入内固定治疗胸腰椎骨折

背景：近年来短节段椎弓根螺钉内固定的使用范围不断扩大,使＂脊柱载荷＂评分系统的可靠性受到质疑,国内外已有报道肯定了短节段椎弓根螺钉内固定对各型胸腰椎骨折的治疗效果。目的：观察短节段椎弓根螺钉置入内固定治疗胸腰椎骨折的临床效果。方法：回顾性分析2007-05/2010-10解放军北京军区总医院骨科收治的胸腰椎骨折患者38例,均经后路短节段椎弓根螺钉内固定治疗。结果与结论：38例患者均获得随访,随访时间10.3-28.9个月;末次随访平均相对后凸畸形Cobb角9.0°,平均矫正丢失6.3°。A、B、C型骨折末次随访平均矫正丢失分别为6.4°,5.7°,7.4°;脊柱载荷评分≤6分末次随访平均矫正丢失5.7°,脊柱载荷评分≥7分末次随访平均矫正丢失7.5°;胸腰段骨折（T11-L2）和下位腰椎骨折（L3-L5）末次随访平均矫正丢失分别为6.3°,6.5°。11例（30%）矫正丢失大于10°,平均11.5°（10.1°-16.3°）,其中A型骨折组4例,B型组4例,C型组3例;脊柱载荷评分≤6分组5例,在脊柱载荷评分≥7分组6例;组间差异均无显著性意义。提示短节段椎弓根螺钉内固定能够有效地治疗胸腰椎骨折患者,不受限于AO骨折分型及脊柱载荷评分,对于治疗胸腰段骨折和下腰椎骨折,疗效基本一致。

Short-segment pedicle instrumentation for the treatment of thoracolumbar fractures

BACKGROUND： Nowadays, the short-segment pedicle instrumentation has been widely used which makes the reliability of the ＂spine load＂ scoring system to be questioned, lots of related reports have confirmed the effect of short-segment pedicle instrumentation for the treatment of thoracolumbar fractures. OBJECTIVE： To observe the effect of short-segment pedicle instrumentation for the treatment of thoracolumbar fractures. METHODS： A retrospective analysis was performed on 38 patients with thoracolumbar fractures selected from the Department of Orthopedics, the General Hospital of Beijing Military Area Command of Chinese PLA from May 2007 to October 2010, all the patients were treated with posterior short-segment pedicle instrumentation. RESULTS AND CONCLUSION： All the 38 patients were followed-up for 10.3-28.9 months. The average relative kyphosis Cobb angle at the final follow-up was 9.0°, with an average loss of correction of 6.3°. The average loss of correction was 6.4° in type A fractures, 5.7° in type B fractures, 7.4° in type C fractures; the average loss of correction was 5.7° for Load Sharing Classification point of ≤6 and 7.5° for Load Sharing Classification point of≥7. The average loss of correction among the patients of thoracolumbar fractures （T11-L2） and lower lumbar fracture （L3-L5） was 6.3° and 6.5°, the loss of correction of 11 patients （30%） was more than 10°, the average loss of correction was 11.5° （10.1°-16.3°）, and 4 patients in type A fractures, 4 patients in type B fractures, 3 patients in type C fractures, and 5 patients in Load Sharing Classification point of ≤6, 6 patients in Load Sharing Classification point of ≥7. There was no significant difference between different groups. Our data suggest that short-segment pedicle instrumentation can be successful for the treatment of thoracolumbar fractures regardless the AO fracture classification and Load Sharing Classification characteristics of the fracture pattern. The effect of short-segment pedicle instrumentation for the treatment of thoracolumbar fractures and lower lumbar fracture is similar.