三节段以上椎弓根螺钉内固定在脊柱损伤治疗中的应用

目的:评价三及四对椎弓根螺钉内固定在脊柱损伤治疗中的意义。方法:对208例行后路椎弓根螺钉内固定手术的病例行回顾性分析,按骨折类型的不同分为压缩骨折组,爆裂骨折组,骨折脱位组,多节段脊柱损伤组。对爆裂骨折组及骨折脱位组行两节段椎弓根螺钉内固定及三节段以上椎弓根螺钉内固定的疗效进行对比分析。结果:行两对椎弓根螺钉内固定者5例术后出现损伤平面再次移位,而使用三或四对椎弓根螺钉行内固定者没有此现象,同时三或四对椎弓根螺钉内固定在椎弓根螺钉松动、断裂方面低于两对椎弓根螺钉内固定者。结论:伴有移位的脊柱骨折,在损伤椎体的上或下位两个椎体内使用两对椎弓根螺钉固定对减少术后再移位,维持脊柱稳定性是必要的。

Application of more than three pairs of pedicle screws internal fixation in the treatment of spinal injury

Objective To evaluate the effective significance of the long segment pedicle screw internal fixation (SPSIF) used in spinal injury. Method 208 cases underwent SPSIF from August 2000 to March 2005 were analyzed retrospectively. They were divided into 4 groups according to the fracture type as follows: the simple compression fracture group, the burst fracture group, the dislocation group and the multiple segment spinal injury group. The therapeutic effects of the short SPSIF and the long SPSIF in the burst fracture group and the dislocation group were analyzed. Results 5 patients underwent the short SPSIF showed vertebrae shifte somehow, while those underwent the long SPSIF seemed steady, and the long SPSIF showed lower incidence in loose and rupture of the screw than the short SPSIF. Conclusion The long SPSIF is an effective way to treat spinal injury with lateral shift, and anatomic reduction of the lateral and sagittal shift before fixation and bone graft fusion are necessary.