后路经伤椎置钉短节段复位固定治疗胸腰椎骨折

目的：探讨后路经伤椎椎弓根置钉短节段复位固定治疗胸腰椎骨折的可行性、适应证及临床疗效。方法：自2007年3月至2009年3月,采用椎弓根螺钉系统同时经伤椎置钉复位固定治疗胸腰椎骨折患者43例,男31例,女12例;年龄26～56岁,平均36.6岁。其中单椎体骨折34例,双椎体骨折4例（邻近骨折3例,跳跃骨折1例）,骨折脱位5例。脊髓神经损伤按Frankel分级：A级5例,B级2例,C级9例,D级7例,E级20例。分别于术后3～5d、12个月、末次随访时复查X线片及CT,对伤椎Cobb角、椎体压缩百分比、椎管占位、内固定物状况进行随访;通过Frankel标准对脊髓神经功能进行评定。结果：所有病例均获得随访,时间12～36个月,平均18.3个月。所有病例均获得骨性融合,无假关节形成。未出现内固定物断裂、松动等现象。伤椎Cobb角由术前的（24.5±9.5）°矫正至术后（5.3±5.1）°,末次随访时（6.2±4.7）°;椎体压缩百分比由术前（42.3±11.1）%恢复至术后（5.1±5.2）%,末次随访时（6.5±5.4）%;术后与术前比较差异有统计学意义（P〈0.05）,末次随访时与术后比较差异无统计学意义（P〉0.05）。椎管矢状径占位率由术前的（34.9±11.2）%恢复至术后（5.3±4.7）%、术后12个月时（5.4±4.5）%,术后与术前比较差异有统计学意义（P〈0.05）,术后12个月与术后比较差异无统计学意义（P〉0.05）。脊髓神经功能除3例A级无变化外,其余均有1～2级的恢复。结论：后路经伤椎置钉短节段复位固定可纠正后凸畸形、椎体压缩及椎管占位,促进脊髓神经功能恢复,是治疗胸腰椎骨折的有效方法之一。

Surgical treatment of thoracolumbar fractures by using reduction and short-segment pedicle screw at the fracture level

Objective: To evaluate the efficacy,indication and clinical outcome of the treatment of thoracolumbar fractures by using reduction and pedicle screw at the fracture level. Methods: From March 2007 to March 2009,43 patients with thoracolumbar fracture underwent surgical procedure of reduction and pedicle screw at the fracture level,included 31 males and 12 females,with an average age of 36.6 years old ranging from 26 to 56. Of all the patients,there were 34 of single vertebral fracture,4 patients of double vertebral fracture and 5 patients of fracture and dislocation. The spinal cord function was classified by Frankel scale as grade A in 5 cases,grade B in 2 cases,grade C in 9 cases,grade D in 7 cases and grade E in 20 cases. X-rays and CT scans were performed after operation,Cobb angle of the injured vertebral segment,the percentage of vertebral compression,and sagittal diameter stenosis rate of the injured spinal canal were observed for radiographic evaluation. Neurological function was evaluated by the Frankel scale. Results: All patients were followed-up from 12 to 36 months(means 18.3 months). There was no pseudoarticulation,solid bone fusion was achieved in all cases. There were no complications such as loosening and rupturing of internal fixation and so on. Cobb angle of the injured vertebral segment was corrected from preoperative (24.5±9.5) degree to postoperative (5.3±5.1) degree and (6.2±4.7) degree at last follow-up. The percentage of vertebral compression was corrected from preoperative(42.3±11.1)% to postoperative (5.1±5.2)% and (6.5±5.4)% at last follow-up. Spinal canal sagittal diameter stenosis rate was corrected from preoperative(34.9±11.2)% to postoperative(5.3±4.7)% and (5.4±4.5)% one year after operation. The spinal cord function was improved 1 to 2 degree in all patients except 3 patients of grade A. Conclusion: Using reduction and short-segment pedicle screw at the fracture level can help the correction of kyphosis,vertebral compression and spinal canal encroachment,and promote the spinal cord function recovery of patients with thoracolumbar burst fracture. It is an effective method to treat thoracolumbar fractures by using reduction and short-segment pedicle screw at the fracture level.