经伤椎椎弓根植骨联合伤椎置钉治疗胸腰椎爆裂骨折

目的探讨经伤椎椎弓根植骨联合伤椎置钉治疗胸腰椎爆裂骨折的临床疗效。方法回顾性分析本院2008年3月～2010年1月经伤椎椎弓根植骨联合伤椎置钉治疗胸腰椎爆裂骨折病例资料59例，其中，男38例，女2l例；年龄19～65岁，平均37岁。收集的病例均为单节段椎体爆裂性骨折，所有病例采用后路经伤椎椎弓根植骨。经伤椎及上下椎椎弓根固定。比较术前术后椎体前缘高度、脊柱后凸角（矢状面Cobb角）、椎管内占位、神经功能ASIA分级等指标。结果术后随访12～24个月，平均随访17个月，术后均获得较好恢复，高度及外形基本恢复正常．无内固定物松动、断裂等并发症，手术前后椎体前缘高度、脊柱后凸角、椎管内占位比较差异均有统计学意义（p〈0．05），神经功能ASIA分级亦有改善。结论经伤椎椎弓根植骨联合伤椎置钉治疗胸腰椎爆裂骨折可有效建立椎体前中柱稳定性，增强内固定系统的牢固性，是治疗胸腰椎爆裂骨折的一种有效方法。

Treatment of thoracolumbar burst fracture with pedicle screw fixation and transpedicular introcorporeal grafting

Objective To explore the clinical efficacy of transpedicular introcorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra for thoracolumbar fractures treatment.Methods A total of 59 patients of thoracolumbar fractures were treated with transpedicular introcorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra from March 2008 to January 2010.Preoperative and postoperative X-rays were performed for evaluating anterior heights of the injured vertebra and Cobb’s angle,as well.Preoperative and postoperative CT scans were taken to measure the sagittal canal diameter.Postoperative complications and neurofunctional recovery of the spinal cord were evaluated.Results All cases were followed up about 12 to 24 months,averagely 17 months.There was no implant failure and no loss of spinal curvatures.There were significant differences of the anterior heights of the injured vertebra and Cobb’s angle and sagittal canal diamenter between follow ups and before operation(P < 0.05).The neurofunctions also showed some improvement compared with the findings before operation.Conclusion Transpedicular introcorporeal grafting combined with posterior short-segment pedicle screw via the injured vertebra can reconstruct the stability of thoracolumbar fractures,stable reconstruction of the anterior and middle columns of the spine.This technique is an effective method for treatment of thoracolumbar fractures.