AF椎弓根螺钉内固定系统治疗胸腰椎爆裂性骨折：30个月随访的中远期效果分析

背景：研究证实后路短节段椎弓根螺钉系统治疗无神经症状的胸腰椎爆裂性骨折，能够提供足够的稳定性，有效恢复椎体高度、生理弧度和椎管容积。 目的：评价AF椎弓根螺钉内固定系统治疗胸腰椎骨折的效果。 方法：分析51例应用AF经椎弓根内固定系统治疗胸腰椎爆裂性骨折患者内固定治疗的中远期疗效。利用X射线片检查内固定前后、拆除内固定前、拆除内固定后随访时的椎体前后缘高度和计算Cobb’s角，CT观察椎管占位情况，利用Frankel分级评估神经功能恢复情况，Christian评分评价功能情况，Denis分级评估疼痛程度。 结果与结论：患者均随访30个月以上。与内固定前比较，内固定后、拆除内植物及末次随访时Cobb’s角及椎体前、后缘高度明显增加(P < 0.01)，CT观察椎管占位明显恢复。内固定前存在脊髓不完全损伤24例，内固定后完全恢复22例。功能活动Christian评分：3分1例，4分3例，5分15例，6分20例，7分12例。腰痛程度按Denis评估，无痛42例，偶有微痛9例。满意度患者自我评测：非常满意35例，满意16例。内固定钉断裂1例1枚。表明AF椎弓根内固定系统能达到满意复位、牢固固定、有效椎管减压的目的，能有效治疗胸腰椎骨折。 关键词：胸椎；腰椎；骨折；AF椎弓根系统；治疗结果 doi:10.3969/j.issn.1673-8225.2012.13.023

AF pedicle screw internal fixation system for thoracolumbar burst fractures: Medium- and long-term curative effects during 30 months follow-up

BACKGROUND: Previous studies have confirmed that posterior short-segment pedicle screw system for the treatment of thoracolumbar burst fractures with none-neurological symptoms can provide enough stability and restore vertebral body height, physiological curvature, spinal curvature and spinal canal volume efficiently. OBJECTIVE: To evaluate the clinical curative of AF pedicle screw internal fixation system for thoracolumbar fractures. METHODS: Fifty-one cases of thoracolumbar burst fractures treated with AF pedicle screw internal fixation system were included. The height of anterior and posterior vertebral border was measured by X-ray before and after operation, before and after the removal of internal fixation, respectively, and all corresponding Cobb angles were calculated. The extent of vertebral protrusion was examined by CT scan, neural function were measured by Frankel scoring. Christian grade and Denis pain grade were obtained respectively. RESULTS AND CONCLUSION: All the patients were all followed-up for over 30 months. Compared with before internal fixation, the height of anterior and posterior vertebral border and Cobb angle were significantly increased and CT scan detected vertebral protrusion was obviously restored after internal fixation, before removal of internal fixation and follow-up after removal of internal fixation (P < 0.01). A total of 24 cases had spinal cord dysfunction preoperatively, and 22 patients obtained complete recovery after the surgery. With respect to Christian grades: 3 points in 1 case, 4 points in 3 cases, 5 points in 15 patients, 6 points in 20 cases, 7 points in 12 cases. After the operation, Denis score system detected P1 (without pain) in 42 cases, P2 (between whiles minute pain, need not treatment) in 9 cases. Self-evaluation satisfaction, 35 patients were very satisfied and 16 cases were satisfied with this treatment. A pedicle screw was broken in one case. It is indicated that AF pedicle screw internal fixation system can treat thoracolumbar fractures effectively and achieve satisfactory reduction, reliable fixation and decompress spinal canal effectively.