后路椎弓根钉棒短节段固定治疗AO-B1型胸腰椎骨折脱位

目的探讨后路椎弓根钉棒短节段固定治疗AO-B1型胸腰椎骨折脱位的疗效。方法对12例AO-B1型胸腰椎骨折脱位伴脊髓损伤患者行一期后路经骨折脱位间隙相邻上下椎弓根置钉、复位、植骨融合并椎弓根钉棒系统两节段内固定。X线检查了解手术前后及末次随访时胸腰椎骨折脱位椎间隙、骨折椎体高度恢复及脱位畸形矫治情况;Frankel分级方法比较手术前后脊髓损伤恢复情况。结果 12例均获随访,时间12~36(23±5)个月。术后Frankel分级:A级9例中1例恢复至C级,1例恢复至D级,余7例双下肢瘫痪均未恢复;C级2例和D级1例末次随访时均恢复至E级。术后及末次随访时影像学检查提示:内固定物在位,12例矢状面脱位均完全纠正,复位率达100%。椎间隙及椎体高度恢复,末次随访时高度无明显丢失,均无钉棒断裂现象。3例出现明显邻近节段退变。结论 AO-B1型胸腰椎骨折脱位可选择4钉2棒短节段固定;术前CT检查对诊断与治疗非常必要。

Posterior pedicle screw short-segment internal fixation in the treatment of type AO-B1 thora-columbar vertebrae fracture-dislocations

Objective To evaluate the clinical efficacy of the posterior pedicle screw short-segment internal fixation for type AO-B1 thoracolumbar vertebrae fracture-dislocations. Methods 12 cases of the type AO-B1 fracture-dislo-cations of thoracic and thoracolumbar vertebrae with spinal cord injury were analyzed retrospectively. One-stage all patients were treated with redution, strut bone grafting, two-segment pedicle screw rod fixation through the fractured-dislocated vertebrae. The interval of the dislocated vertebrae, the height recovery of the fractured vertebrare body, and the deformity correction of the fracture-dislocations were evaluated by X-rays, and neurologic status were evalua-ted by Frankel classification before and after operation and at final follow-up. Results 12 patients were followed up for 12-36 （23 ± 5） months. Postoperative Frankel′s functional classification：Grade A was improved to C in 1 case, Grade A to D in 1,the lesions remained unchanged in 7;Grade C to E in 2 and Grade D to E in 1. Radiographic ima-ging displayed internal fixation in the correct position. The dislocation in sagittal plane in all of 12 patients had been completely corrected,the rate of deformity correction was 100%. The height of the fractured vertebrae and interval of the dislocated vertebrae had been recovered. No sign of breakage of pedicle screw and connection rod had been seen. There was no obvious evidence of correction loss at final follow-up. There were 3 cases of apparent adjacent segment degeneration. Conclusions It is an effective method to treat type AO-B1 thoracolumbar vertebrae fracture-disloca-tions with two-segment pedicle screw fixation through the fractured vertebrae. It is very necessary for CT examination preoperative in the diagnosis and treatment.