椎弓根螺钉结合骨盆牵引治疗中老年胸腰椎爆裂性骨折

目的探讨中老年人胸腰椎爆裂性骨折的治疗方法。方法回顾2004年8月至2010年2月,使用胸腰椎后路椎弓根螺钉固定结合术前骨盆牵引的方法治疗中老年人胸腰椎爆裂性骨折的55例患者,男38例,女17例。患者年龄50～74岁,平均年龄58.4岁,平均伤后6.8d行胸腰椎后路手术治疗。骨盆牵引后仍存在神经受损症状的患者,行胸腰椎后路椎板减压,骨折椎体敲击复位,植骨融合内固定术;牵引后神经损害症状完全消失的患者则行后路复位植骨融合椎弓根螺钉固定术。术后平均随访时间2年半。结果经术前骨盆牵引,患者骨折椎体的前后缘高度、后突Cobb角得到明显纠正,患者神经症状恢复明显。本组病例中,8例患者经术前骨盆牵引,神经症状得到完全恢复。椎板打开减压组的手术平均出血量以及手术时间明显多于非减压组。经最终随访,所有患者骨折均愈合,无断钉或螺钉松动等并发症,35例伴有神经损伤的患者中,20例神经症状完全恢复,11例存在少量神经损伤残留症状。结论椎弓根螺钉结合骨盆牵引治疗中老年人胸腰椎爆裂性骨折,可减少手术操作的创伤,增加手术的成功率,有助于患者的最终恢复。

Pedicle screws fixation combined with pelvic traction for treating thoracic lumbar burst fracture in elders

Objective To explore an effective and feasible way to treat thoracic lumbar burst fracture in older patients. Methods Fifty-five patients（from 50 to 74 years of age,average age 58.4 years） suffered from thoracic-lumbar burst fractures were treated between August 2004 and February 2010.The mean time of pelvic traction lasted 6.8 days.All patients were treated with pedicle screws fixation combined with pelvic traction before operation.And the patients without neurologic deficits were only operated with vertebral body reduction,pedicle screw fixation and posterolateral bone fusion, while patients with neurologic deficits were performed with spinal decompression additionally.The mean follow-up time was two and half years.Results By pelvic traction,the height of posterior and anterior edge of fractured vertebral body and the Cobb angles were reduced significandy.Neurologic symptoms of patients were also obviously relieved.Among 35 patients with neurologic deficits,the neurologic symptoms of 8 patients recovered completely after pelvic traction,and 20 patients got complete recovery of neurologic function at follow-up.The operative time and blood loss were more in the patients operated with spinal decompression than operation without spinal decompression.Bony fusion was achieved in all patients. No height loss of vertebral body or Cobb angles increasing was observed at follow-up.Conclusion The pedicle screws fixation combined with pelvic traction will diminish the trauma of operation,which was beneficial for older patients.