短节段椎弓根螺钉内固定治疗单节段胸腰段爆裂骨折的远期疗效分析

目的:分析短节段跨伤椎椎弓根螺钉内固定治疗单节段脊柱胸腰段爆裂性骨折的远期临床效果。方法:采用短节段(四钉两棒)椎弓根螺钉内固定系统治疗单节段胸腰段爆裂性骨折46例。术后12个月常规拔除内固定,术后随访18~36个月。结果:术后即刻椎体高度较术前显著增长(P<0.01),后凸畸形较术前明显改善(P<0.01),螺钉位置及稳定性良好,未出现脊髓神经症状加重。随访过程中,6例出现内固定断裂,末次随访时椎体高度较术后即刻减少(P<0.01),末次随访时后凸角较术后即刻增大(P<0.01)。Denis疼痛工作评分,P1W1:9例(25%),P2W2:26例,P3W2:7例,P3W3:4例。结论:短节段跨伤椎椎弓根螺钉内固定治疗单节段胸腰椎爆裂性骨折并发症较多,远期效果难以维持,临床应用应谨慎。

Long-term effect of short-segment pedicle screw internal fixation in the treatment of single-level thoracolumbar bursting fracture

Objective:To analyzed the long-term clinical effects of the short-segment pedicle screw internal fixation in the treatment of single-level thoracolumbar bursting fracture. Methods:Forty-six cases with single-level thoracolumbar bursting fracture were treated with short-segment pedicle screw( four screws two rods) internal fixation. The internal fixations were removed at 12 months after operation. All cases were followed up for 18 to 36 months. Results:Compared before operation, the anterior height of vertebral body recovered immediately after operation(P<0. 01),the Kyphosis after operation was improved significantly(P<0. 01). Screw position and stability were good,no aggravation of spinal cord neurological symptom was found. During the following-up period,the internal fixation fracture in 6 cases were identified. Compared immediately after operation,the anterior height of vertebral body decreased at the end of the following-up(P<0. 01). The P1W1 in 9 cases(25%),P2W2 in 26 cases,P3W2 in 7 cases and P3W3 in 4 cases were found according to the Denis pain score. Conclusions:The short-segment pedicle screw internal fixation in the treatment of single-level thoracolumbar bursting fracture has some complications,the long-term effect of which is difficult to maintain,and its clinical application should be cautious.