经伤椎内固定椎间椎体内打压植骨治疗胸腰椎骨折

目的探讨后路经伤椎短节段复位内固定联合椎间椎体打压植骨治疗胸腰椎骨折的疗效。方法采用经伤椎后路复位短节段内固定、椎间椎体内植骨治疗21例胸腰椎骨折患者。根据术前、术后1周及末次随访时正、侧位X线片评判术后伤椎椎体前缘高度、后凸Cobb角恢复及内固定失败和骨融合情况。结果患者均获随访,时间12~32个月。未见断钉断棒及内固定松动。伤椎及椎间植骨均获骨性愈合。伤椎椎体前缘高度:术后1周为95.1%±3.2%,末次随访时为93.9%±3.6%,均较术前39.6%±10.3%明显改善(P0.01)。损伤节段后凸Cobb角:术后1周为12.2°±2.9°,末次随访时为12.9°±3.5°,均较术前(33.7°±6.2°)明显恢复(P0.01)。末次随访时与术后1周比较,伤椎椎体前缘高度和Cobb角均无明显变化(P0.05)。结论后路经伤椎短节段内固定联合椎间及伤椎打压植骨治疗胸腰椎骨折,重建了椎间和椎体的稳定性,有助于减少术后内固定失败及矫正丢失。

Interbody fusion and transpedicular grafting following posterior reduction and short-segment instrumentation for thoracolumbar fracture using pedicle screws at the fracture level

Objective To explore the efficacy of posterior reduction and short-segment instrumentation for thoracolumbar fracture using pedicle screws at the fracture level combined with interbody fusion and transpedicular grafting. Methods 21 patients with thoracolumbar fracture were treated with posterior reduction and short-segment instrumentation using pedicle screws at the fracture level combined with interbody fusion and transpedicular grafting. The anterior vertebral body height of the injured vertebra, the segmental Cobb angle, bone graft healing were assessed under plain anteroposterior and lateral radiographs at preoperation, one-week after operation, and at the final follow-up. Resuits All patients had solid fusion without implant failure within 12 ～ 32 months of follow-up. The anterior vertebral body height was 95.1% ＋3.2% at one-week after operation and 93.9% ±3.6% at the final follow-up. Compared with that at pre-operation （39. 6% ±10. 3% ）, they were both improved significantly （ P 〈 0. 01 ）. The segmental Cobb angle were 12. 2°± 2. 9° at one-week after operation and 12. 9°± 3.5° at the final follow-up. Compared with that at pre-operation （33.7° ±6. 2°）, they were also both improved significantly （P 〈0.01 ）. Both the anterior vertebral body height and the segmental Cobb angle at the final follow-up were similar with that at one-week after operation （P 〉 0. 05）. Conclusions Posterior reduction and short-segment instrumentation using pedicle screws at the fracture level combined with interbody fusion and transpedicular grafting is feasible and reliable for thoracolumbar fracture reducing hardware failure and correction loss with one-stage posterior approach.