经伤椎置钉内固定治疗胸腰椎骨折46例报告

目的:探讨分析经伤椎置钉内固定治疗胸腰椎骨折的临床疗效;方法:回顾性分析自2008年8月至2010年8月经伤椎置钉内固定治疗且满2年随访时间的46例胸腰椎骨折患者。比较患者术前、术后14天、术后2年的患者Cobb角、椎体前缘高度恢复程度以及椎管占位情况。并按Frankel脊髓神经功能障碍分级标准评价患者神经损伤及恢复情况,利用视觉模拟评分评价临床疗效。结果:46例患者在2年的随访时间里只有1位患者内固定断裂,1位患者螺钉松动,其余患者无内固定并发症发生。通过影像学观察,患者术后即刻Cobb角,伤椎前缘高度及椎管占位情况较术前有明显改善(P<0.05);术后2年患者Cobb角,伤椎前缘高度及椎管占位情况较术后14天没有明显丢失(P>0.05)。患者术后Frankel分级及视觉模拟评分均较术前有明显改善(P<0.05),术后2年Frankel分级及视觉模拟评分均较术后14天有明显改进(P<0.05);结论:经伤椎置钉内固定治疗胸腰椎骨折具有术后内固定并发症少,可以有效纠正胸腰椎畸形且畸形纠正度丢失少等优点,是治疗胸腰椎骨折的有效方法。

Effect of internal fixation with screw through pedicle of fractured vertebra on thoracolumbar fractures

Objective: To explore clinical effect of internal fixation with screw through pedicle of fractured vertebra on thoracolumbar fractures.Methods: A total of 46 patients with thoracolumbar fracture from August 2008 to August 2010 were selected.All the patients were followed up for at least two years.There were 28 males and 18 females with an average age of(40.5±10.7) years old(ranged,21 to 60 years).The Cobb's angle,restoration of the anterior height of the injured vertebra,improvement of spinal canal stenosis rate were compared before surgery,two weeks after surgery and two years after surgery.The spinal cord function was assessed according to Frankel grade.And efficacy was analyzed by VAS.Results:There was 1 case with screw breakage and 1 case with loosening internal fixation.The Cobb's angle before surgery were significantly smaller than that of two weeks after surgery(P<0.05).The Cobb's angle of two weeks after surgery were similar to that of two years after surgery(P>0.05).The anterior height of the injured vertebra,and spinal canal stenosis rate were improved two weeks after surgery(P<0.05).The anterior height of the injured vertebra,and spinal canal stenosis rate of two weeks after surgery were similar to that of two years after surgery(P>0.05).Frankel grade and VAS before surgery were improved when compared with that two weeks after surgery(P<0.05).Two years after surgery,Frankel grade and VAS were improved when compared with taht two weeks after surgery(P<0.05).Conclusions: The screw fixation through the pedicle of fractured vertebra is of little complicating,and can effectively correct thoracolumbar spine deformity.The correctness lost is also few.It is an effective treatment for thoracolumbar fractures.