有限减压相邻节段植骨内固定术治疗胸腰椎骨折

目的]研究有限减压相邻节段椎弓根内固定椎间、椎内植骨融合术治疗胸腰椎骨折的可行性和临床疗效。方法]回顾性研究应用该技术治疗的43例胸腰椎骨折患者,观察植骨融合及复位情况、神经功能恢复情况,及矫正丢失、腰痛后遗症和融合椎体相邻椎间盘退变等并发症发生情况。结果]平均随访21.4个月,所有患者均达到坚强骨性融合,均得到满意的复位,复位率达96.1%,近期内无明显矫正丢失,术后神经功能均得到不同程度的恢复,术前术后秩和检验P<0.01,且融合节段相邻椎间盘退变率仅为4.65%,未出现顽固性腰痛、腰椎活动受限等并发症,临床疗效明显优于长节段内固定。结论]只要适应证选择合适,有限减压相邻节段内固定椎间、椎内植骨融合内固定术不但可以达到满意复位、坚强骨性融合,而且可以明显降低顽固性腰痛、相邻椎间盘退变等并发症的发生率。

Treatment of thoracolumbar vertebral fracture by limited decompression of neighbouring segment with internal fixation and intervertebral body fusion

Objective]To study the feasibility and clinical effect of the treatment of thoracolumbar vertebral fracture with limited decompression of neighbouring segments with internal fixation and intervertebral body fusion.Method]Forty-three patients with thoracolumbar fractures were treated with this technique.The fusion of bone graft,reduction rate of fracture,nerve functional recovery,the loosening of rectification,subsequent low back pain,and the degeneration of adjacent segments were evaluated.Result]All cases were followed up for 21.4 months and showed the results of strong spine bony fusion,96.1% satisfactory reduction rate without reduction lost,various differences of nerve functional improvement,a rank-sum test P<0.01,4.65% adjacent intervertebral disc degeneration rate,no recurrence of low back pain,no limitation of motion of lumbar et al.Conclusion]If suitable indication was choosed,the treatment of thoracolumbar fracture by limited decompression of neighbouring segments with internal fixation and intervertebral body fusion can not only get a result of strong spine bone fusion with satisfactory reduction of fracture,but also obviously decrease the incidence of postoperative recurrence of low back pain and subsequent adjacent intervertebral degeneration.