椎弓根螺钉置入内固定治疗胸腰段骨折脱位后脊柱的生物力学变化

背景：对于胸腰段椎体爆裂性或粉碎性骨折，临床多行前路减压、植骨融合、钢板螺钉置入内固定。后路手术包括椎板切除减压、椎弓根螺钉置入内固定。 目的：探讨椎弓根螺钉置入内固定系统治疗胸腰段骨折脱位后脊柱的生物与力学变化。 方法：胸腰段骨折脱位的患者46例，给予椎弓根螺钉置入内固定系统治疗，观察内固定前后、当时及随访1年后脊髓损伤恢复情况及骨折复位情况。 结果与结论：46例患者均获得随访，采用Frankel功能分类法评估脊髓损伤的分级，各时期A级所占百分比差异无显著性意义(P > 0.05)，螺钉置入内固定后当时及随访1年后B-E级与内固定前比较，均有显著性意义(P < 0.05)，但内固定后当时与随访1年后比较，差异无显著性意义(P > 0.05)。采用前缘高度百分比、后缘高度百分比、Cobb角等指标评估骨折复位情况，各时期后缘高度比较，差异无显著性意义(P > 0.05)，螺钉置入内固定后当时及随访1年后的前缘高度、Cobb角与内固定前比较，差异均有显著性意义(P < 0.05)，但内固定后当时与随访1年后比较，差异无显著性意义(P > 0.05)。说明针对胸腰段骨折脱位的患者实施椎弓根置入内固定系统治疗，有利于骨折复位及脊髓神经功能恢复。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：

Biomechanical changes of spine after thoracolumbar fracture and dislocation treated with pedicle screw internal fixation

BACKGROUND:Anterior decompression, bone graft fusion, plate and screw fixation are commonly used in clinic for the treatment of thoracolumbar burst or comminuted fractures. The posterior surgery including decompression laminectomy and pedicle screw internal fixation. OBJECTIVE:To explore the biomechanical changes of spine after thoracolumbar fracture and dislocation treated with pedicle screw internal fixation. METHODS: Forty-six patients with thoracolumbar fracture and dislocation were treated with pedicle screw internal fixation, and then the recovery of spinal cord injury and fracture reduction were observed after internal fixation, immediately after internal fixation and 1-year follow-up. RESULTS AND CONCLUSION: All the 46 cases were followed-up. Frankel function classification assessment was used to evaluate the spinal cord injury grade. There was no significant difference in the percentage of A grade between periods (P > 0.05), and there were significant differences in the percentage of B-E grades when compared between immediately postoperative period, 1-year follow-up period and preoperative period (P < 0.05), but there was no significant difference when compared between immediately postoperative period and 1-year-follow period (P > 0.05). The anterior height percentage, posterior height percentage and Cobb angle indicators were used to assess the fracture reduction, and the results showed there was no significant difference in posterior height between periods (P > 0.05), and there was significant difference in Cobb angle when compared between immediately postoperative period, 1-year follow-up period and preoperative period (P < 0.05), but there was no significant difference between immediately postoperative period and 1-year follow-up period (P > 0.05).   The results indicate that pedicle screw internal fixation system for the treatment of thoracolumbar spinal fracture and dislocation is conducive to the fracture reduction and functional recovery.