经后路椎弓根螺钉内固定治疗不稳定上胸椎骨折临床观察

目的 观察经后路椎弓根螺钉内固定技术治疗不稳定上胸椎骨折的临床疗效。方法 回顾性分析2010年3月至2013年4月收治的21例不稳定上胸椎骨折患者临床资料。骨折节段为T3～T8，均为高能量损伤。所有患者实施经后路切开复位、脊髓减压、椎弓根螺钉内固定、后外侧植骨融合术。术后常规处理，并接受早期康复治疗。对手术前后患者的①基本情况；②影像学评价（包括椎弓根螺钉位置、椎体压缩率、椎体后凸角度）；③脊髓神经功能分级（ASIA ）；④日常生活活动能力（ADL ）评分进行评价。结果 21例患者全部顺利完成手术，无术后出现并发症。20例患者获得有效随访，随访时间为12～49个月，平均随访时间（28．78±6．25）个月。术后48 h及随访时的椎体压缩率、椎体后凸角均较术前降低（ P ＜0．01），但随访时的椎体压缩率、椎体后凸角则均较术后48 h有所增加（ P ＜0．05）。术后48 h脊髓损伤ASIA分级均无明显变化。随访时，50．0％病例的脊髓损伤ASIA分级得到恢复，日常生活活动能力（ADL ）评分在随访时得到显著提高（ P ＜0．05） ，平均提高（22．11±9．64）分。结论 经后路椎弓根螺钉内固定技术是治疗不稳定上胸椎骨折的有效方法，配合术后早期康复治疗是患者脊髓功能恢复的关键。

Clinical Observation on Posterior Pedicle Screw Fixation for the Treatment of Unstable Upper Thoracic Vertebrae Fractures

Objective]To observe clinical efficacy of posterior pedicle screw fixation in the treatment of unstable upper thoracic fractures .[Methods]Clinical data of 21 patients with unstable upper thoracic fractures from March 2010 to April 2013 were analyzed retrospectively .T3 ~ T8 segmental fractures were high‐energy injury .All patients underwent posterior open reduction ,spinal decompression ,pedicle screw fixation ,pos‐terolateral fusion and bone graft .Conventional treatment and early rehabilitation intervention were given after operation .General condition ,radiographic evaluation（including pedicle screw position ,vertebral compression ratio and vertebral kyphosis angle） ,spinal nerve function classification（ASIA） and daily living activity（ADL） before and after operation were evaluated .[Results] All 21 patients successfully completed surgery ,and no postoperative complication occurred .The 20 patients got effective follow up ,and the follow up time was 12~49 months ,and the mean follow up time was （28 .78 ± 6 .25） months .Compared with before operation ,verte‐bral compression rate and vertebral kyphosis angle at 48h after operation and follow‐up were decreased（ P 〈 0 .01） .Compared with 24h after operation ,vertebral compression rate and vertebral kyphosis angle at follow‐up were increased（ P〈 0 .05） .Spinal cord injury ASIA classification at 48h after operation had no change .At follow up ,spinal cord injury ASIA classification of 50 .0% of patients was recovered ,and ADL score was sig‐nificantly improved at follow up（ P 〈 0 .05） ,and increased by average （22 .11 ± 9 .64） points .[Conclusion]Posterior pedicle screw fixation is an effective method for the treatment of unstable thoracic fractures .The op‐eration combined with early postoperative rehabilitation intervention is the key of spinal function recovery .