经伤椎固定治疗胸腰椎骨折的临床研究

目的探讨经伤椎椎弓根螺钉内固定治疗胸腰椎骨折的临床疗效。方法 2008年5月-2010年12月,选择38例胸腰椎骨折患者,采用椎弓根螺钉固定伤椎及相邻上下椎体。其中男28例,女10例;年龄21～65岁,平均36.5岁。骨折部位:胸8 1例,胸9 2例,胸10 4例,胸11 8例,胸12 7例,腰1 10例,腰2 4例,腰3 2例。受伤至手术时间3～7 d,平均4.5 d。对患者手术前后椎体高度、矢状面后凸Cobb角、神经功能Frankel分级变化等指标进行测量并随访。结果术后患者切口均Ⅰ期愈合。38例获随访12～18个月,平均15个月。骨折均获得骨性融合,无钉棒断裂、无死亡或神经损伤加重患者。术后神经功能Frankel分级较术前有明显改善(P<0.05)。术后X线片复查示伤椎高度恢复达90%以上,外形正常;CT复查示椎管内有效矢状径恢复满意,椎管前方无明显骨性压迫,伤椎椎体骨愈合良好。术后1、12个月时伤椎前、后缘高度及后凸Cobb角均较术前显著改善(P<0.05);术后12个月随访椎体高度无丢失。结论经伤椎椎弓根钉复位、减压、内固定治疗胸腰椎骨折具有创伤小、固定节段少、脊柱稳定性好、能有效矫正及预防脊柱后凸畸形等优点。

Clinical Analysis of the Application of Fixation via Injured Vertebra for the Treatment of Thoracolumbar Fracture

Objective To observe the clinical effect of fixation via injured vertebra for the treatment of thoracolumbar fracture.Methods From May 2008 to December 2010,38 patients with thoracolumbar fracture were recruited and the injured vertebra and adjacent vertebrae were fixed with pedicle screws.There were 28 males and 10 females,aged from 21 to 65 years old,averaging 36.5 years.There were 1 case of fracture in T8,2 in T9,4 in T10,8 in T11,7 in T12,10 in L1,4 in L2,and 2 in L3.The time from being injured to operation ranged from 3 to 7 days,averaging 4.5 days.Several parameters including height of fractured vertebra,Cobb’s angle on sagittal plane,Frankel grade of nerve function were detected and followed up.Results All incisions healed during the primary period.The patients were followed up for 12 to 18 months with an average time of 15 months.All fractures gained bone fusion.No broken screws,deaths or nerve injury aggravation occurred.Frankel grade of nerve function significantly bettered after operation(P<0.05).X-ray re-examination showed that the height of fractured vertebra restored higher than 90% with normal shape.CT results showed that the radius vector of the spinal canal restored satisfactorily with good recovery of the injured vertebra.One and 12 months after the operation,the height of injured vertebra and the Cobb’s angle improved significantly(P<0.05).Twelve months after the operation,the vertebrae did not shorten in its height.Conclusion Internal fixation via injured vertebra with pedicle screw to treat thoracolumbar vertebral fracture have several advantages: less trauma,less stiffness,more stable vertebral column,which can rectify and prevent kyphosis effectively.