椎弓根螺钉固定治疗中上胸椎骨折的临床疗效观察

目的观察椎弓根螺钉固定治疗中上胸椎骨折的临床疗效及安全性。方法2007年1月至2011年12月,采用椎弓根螺钉固定治疗中上胸椎骨折35例,术前后测量伤椎前缘高度,使用Frankel分级评定神经功能恢复情况。结果 35例患者均获随访,伤椎前缘高度由术前的平均(46.3%±11.2%)恢复至术后的(89.7%±17.6%),差异有统计学意义(P<0.01)。末次随访时脊髓神经功能改善情况:7例Frankel A级患者未见明显改善,B级12例患者中,有8例恢复到C级,4例恢复到D级;C级8例患者中,有5例恢复到D级,有3例恢复到E级;D级3例患者均恢复到E级。末次随访时骨折达骨性愈合,未发现内固定松动断裂。结论椎弓根螺钉内固定治疗中上胸椎骨折临床疗效肯定,能获得满意的复位。在保证正确选择进针点及进针方向的前提下,椎弓根螺钉在中上胸椎骨折脱位中的应用是安全的。

Clinical Effect of Pedicle Screw Fixation in the Treatment of Upper Thoracic Fractures

Objective To observe the clinical efficacy and safety of pedicle screw fixation in the treatment of upper thoracic fractures. Methods From January 2007 to December 2011, the pediele screw fixation was used in the treatment of thoracic fractures in 35 cases. The pre- and postoperative anterior vertebral height was measured, and the Frankel classification neural function recovery was observed too. Results 35 patients were followed up for 32.5（ 12 ～48） month, the anterior vertebral height got improved from （46.3% ± 11.2% ） preoperatively to （89.7% ± 17.6% ） postoperatively. The Frankel spinal nerve function improvement at the end of the follow-up showed there was no significant improvement in 7 cases of grade A, 8 recovered to grade C and 4 cases to grade D in 12 cases of grade B, 5 recovered to grade D and 3 to grade E in 8 patients of grade C and the other 3 cases of grade D all recovered to grade E. At the last time of follow-up, all fractures had bone fusioned, no internal fixation loose or collapse was observed. Conclusions The pedicle screw fixation can get confirm clinical effect and obtain satisfactory reduction in the treatment of upper thoracic fractures. With the correct choice of the point and the direction of the needling, it is safe of the internal fixation of the thoracic ped- iele screws for the treatment of the upper thoracic fractures and dislocations.