骨折椎垂直应力螺钉在胸腰椎骨折中的应用

目的：探讨对胸腰椎爆裂性骨折应用经骨折椎椎弓应力螺钉加强胸腰椎骨折后路内固定的临床疗效。方法：回顾性研究2007年2月至2009年12月采用骨折椎加用应力螺钉固定22例胸腰椎单一椎体骨折患者的临床资料。其中男15例，女7例，平均年龄38.2岁（21～73岁）。所有患者外伤均不超过1周，骨折椎一侧或双侧椎弓根完整。在施行后路常规撑开和恢复腰椎前凸的同时在骨折椎上应用椎弓根螺钉向垂直于撑开应力方向的腹侧加压，以达到局部的应力平衡。术后随访6～40个月，平均20.3个月。结果：应力螺钉使骨折椎向腹侧移动复位，术后Cobb角及前柱高度恢复较佳。骨折椎加用应力螺钉在前柱撑开的同时可有效控制正常椎间盘高度的撑开。结论：对胸腰椎单一椎体骨折有条件地应用骨折椎椎弓根螺钉可以增强胸腰椎骨折后路短节段内固定系统的牢固性，并有利于矫正后凸畸形和维持矫正效果。

Fixing the vertical stress pedicle screws into the injured vertebra for thoracolumbar fractures

Objective：To explore the technique outcome of fixing the ventral stress pedicle screws into the injured vertebrae , in the treatment of thoracolumbar burst fractures .Methods：From February 2007 to December 2009 , 22 single thoracolumbar fractures were studied retrospectively .Among which 15 males and 7 females,aged 38.2 years averagely （ range ,21~73 years ） .All the patients underwent the operation within 1 weeks after fracture .For the injured vertebral bodies ,their pedicles were intact on either unilateral or bilateral side .The pedicle screws in the injured vertebrae were used to achieve eventral press vertical to the distraction for the stress neutralization ,and also with the routine distraction and lordosis restoration , simultaneously .The mean follow-up period was 20.3 months with a range from 6 to 40 months.Results：After operation,the optimal Cobb angle and anterior column restoration were achieved through the ventral reduction from the injured vertebral body , which was resulted from the vertical stress pedicle screw .And the over-distraction of the contiguous discs was also avoided eficiently .Conclusion： It can enhance the stiffness of the posterior short-segment instrumentation in single thoracolumbar fractures through fixing the pedicle screws into injured vertebrae selectively ,which still can help to correct the kyphosis and maintain the reduction .