经伤椎椎弓根钉固定治疗重度胸腰椎爆裂性骨折的临床疗效研究

目的分析探讨经骨折椎椎弓根固定治疗胸腰椎爆裂性骨折的手术治疗效果。方法回顾性分析本院2004年2月～2008年4月收治的48例胸腰椎爆裂性骨折患者的临床资料。分为2组，A组27例单纯行跨骨折椎的4钉固定术，B组21例行经骨折椎椎弓根6钉固定术。随访6-56个月，平均16．6个月。依据患者骨折椎前缘高度、矢状面Cobb角、神经功能恢复、内固定失败率（断钉、断棒及退钉等）及腰背痛进行评价。结果所有患者均得到随访，无神经功能障碍症状加重患者。2组骨折椎前缘高度、矢状面Cobb角术前、术后差异有统计学意义（P〈0．05），但2组间差异无统计学意义（P〉0．05）。2组的神经功能评定比较差异无统计学意义（P〉0．05），而随访中腰背疼痛及内固定失败率在经伤椎椎弓根固定组均较低，差异有统计学意义（P〈0．05）。结论经伤椎椎弓根钉固定是治疗重度胸腰椎爆裂性骨折的有效手段。

Clinical Study of serious thoracolumbar burst fractures with fixation through the pedicle of fractured vertebrae

Objective To analyze and investigate the clinical results of reduction and fixation through the pedicle of fractured vertebrae in treatment of serious thoracolumbar burst fractures. Methods Clinical data of 48 cases of 1 level serious thoracolumbar burst fracture from December 2004 to April 2008 were retrospectively analyzed. The patients were divided into 2 groups according the operation performed. Twenty-seven cases of Group A were performed pedicle screw fixation with the upper and lower segment of the fractured vertebrae; and 21 cases of Group B were performed internal fixation through the pedicle of fractured vertebrae. All the cases were followed up for 6 - 56 months （ average 16.6 months）, and 2 groups were comparatively analyzed according to the vertebral height, Cobb＇ s angle, nerve functions, internal fixation failure and back pain. Results All the patients were followed up, no neurological deficient worsening happened postoperatively. Postoperative fractured vertebral height and Cobb＇ s angle of 2 groups had significant difference compared with preoperative ones （P 〈 0. 05）. Group B was better than Group A, but no statistical significance （P 〉 0.05）. The nerve functions of 2 groups hadn＇t significant difference, and group B had lower rates of back pain andinternal fixation failure. Conclusion Fixation with transpedicle screw of fractured vertebrae was an effective therapeutic option to treat the serious thoracolumbar burst fractures.