经伤椎椎弓根植骨置钉后路内固定治疗胸腰椎爆裂性骨折

目的：探讨经伤椎椎弓根植骨置钉结合后路椎弓根短节段内固定治疗胸腰椎爆裂性骨折的可行性及临床效果。方法回顾性分析东营市河口区人民医院2008年12月～2011年11月采用经伤椎椎弓根植骨置钉椎结合后路椎弓根短节段固定治疗单节段胸腰椎爆裂性骨折患者36例，男性24例，女性12例；年龄26～62岁，平均39.2岁。损伤节段： T119例，T1213例，L110例，L23例，L31例；致伤原因：道路交通伤15例，高处坠落伤15例，重物砸伤6例。神经功能情况按Frankel分级： B级2例，C级13例，D级6例，E级15例。通过对术前、术后即刻以及终末随访时影像学指标、神经功能的比较分析临床疗效。结果36例均获得随访，随访时间14～60个月，平均21.6个月。术后1.5年随访时按Frankel评价标准均有1～3级不同程度恢复，腰背痛视觉模拟评分（ VAS）较术前明显改善。患者均获得骨性融合，随访影像学检查示椎管狭窄率、Cobb角、伤椎楔变角、下间隙角、上间隙角、伤椎前缘压缩率、伤椎后缘压缩率较术前明显恢复，无内固定松动或断裂等并发症发生。结论经伤椎椎弓根植骨置钉结合后路椎弓根短节段固定治疗胸腰椎骨折能够较好地重建伤椎高度，有效维持伤椎的三柱稳定性，降低了内固定失败发生率，是一种安全、有效的手术方式。

Treatment of burst thoracolumbar fractures with pedicle screws fixation and transpedicular intervertebral bone graft in injured vertebrae

Objective To study the effectiveness of pedicle screws fixation and transpedicular intervertebral bone graft in injured vertebrae for the treatment of thoracolumbar fractures .Methods Thirty six cases of burst thora-columbar fractures from Dec .2008 to Nov.2011 were analyzed retrospectively . All patients were cured by pedicle screws fixation and transpedicular intervertebral bone graft in injured vertebrae .Among them 24 were male and 12 fe-male and the average age was 39.2 years(26-62 years).The injured segments were T11 in 9 cases,T12 in 13 cases,L1 in 10 cases,L2 in 3cases and L3 in 1 case.Fifteen cases were resulted from traffic accidents ,15 from falls and 6 from crushing.Based on Frankel classification ,2 cases were rated as grade B ,13 cases as grade C,6 cases as grade D and 15 cases as grade E .The X-ray film and Frankel classification were conducted to evaluate the function recovery effec -tiveness.Results All the patients were followed up for 14-60 months(mean,21.6 months).The neural function in 36 cases improved 1-3 grades 1.5 years after operation .There was clear relief of pain after surgery ( VAS scores im-proved obviously ) .Films showed good bone graft healing and no loosening or breakage of screws and rods .Radio-graphic index showed significant differences before and after the operation (P<0.01).Conclusion Treatment of burst thoracolumbar fractures with pedicle screws fixation and transpedicular intervertebral bone graft in injured verte -brae has satisfactory effectiveness .It can reconstruct vertebral body height ,increase the stability of three columns of the injured vertebrae and prevent loosening .Pedicle screws fixation and transpedicular intervertebral bone graft in in-jured vertebrae for the treatment of thoracolumbar fractures is worth widely promoting in clinical application .