后路椎弓根钉治疗伴有脊髓损伤的多节段胸腰椎骨折

目的探讨后路椎弓根钉固定治疗伴有脊髓损伤的多节段胸腰椎骨折（multiple—level spinal fracture，MSF）的临床疗效。方法2005年8月至2010年2月，收治18例伴有脊髓损伤的MSF患者，男12例，女6例，年龄20～56岁，平均37岁。其中Ⅰ型（相邻型）10例，Ⅱ型（非相邻型）8例。脊髓损伤按AsIA分级，A级、B级各2例，C级5例，D级9例。18例多节段胸腰椎骨折患者经后路切开复位、椎弓根内固定、椎板减压及后外侧植骨融合治疗，所有患者均于术前、术后、内固定取出前、后拍摄脊柱正侧位x线片和CT片。结果所有病例随访14～30个月，平均随访18个月，术后无内固定物松动、断裂，无继发性脊柱后凸畸形加重，脊髓损伤均有不同程度恢复。结论后路椎弓根固定联合椎板减压能有效恢复椎体高度、重建脊柱稳定性、促进脊髓神经功能恢复，具有手术创伤小、患者术后恢复快等优点，是治疗MSF并脊髓神经损伤的理想方法之一。

Posterior Transpedicular Fixation for the Treatment of Multiple Thoracolumbar Fracture with Spinal Cord Injury

Objective To investigate the clinical curative effect of posterior transpedicular fixation for the treatment of multiple thoracolumbar fracture with spinal cord injury. M.ethods From August 2005 to February 2010,18 patients of multiple thoracolumbar fracture with spinal cord injury were treated, 12 males and 6 females,aged 20-56 years old （37 on average）. Ten cases were Ⅰ type （adjacent type） fracture,8 were Ⅲ type （non-adjacent type） fracture. According to the ASIA grade,there was 2 cases of grade A,2 of grade B,5 of grade C and 9 of grade D. 18 patients were surgically treated through posterior approach by open reduction, transpedicular fixation, vertebral canal decompression and followed by posterior lateral bone graft fusion. All cases were checked with radiography and CT scan before/after operation and implant removal. Results All cases were followed up for 14-30 months（average 18 months）. No implant failure and late kyphosis deformity was observed. The postoperative neurological function was improved. Conclusion Posterior transpedicular fixation, vertebral canal decompression and posterior lateral bone graft fusion can achieve effective reduction for the fractured vertebrae and simultaneously restore spine stability. This operation is an ideal choice for surgical treatment of multiple thoracolumbar fracture with spinal cord injury with simple anatomy,minimally invasion and patients recover faster and so on.