后路伤椎植骨内固定加椎管成形治疗胸腰椎严重爆裂性骨折

目的:探讨后路经椎弓根通道椎体内植骨椎弓根螺钉内固定加自体髂骨移植椎管成形治疗严重胸腰椎爆裂性骨折的临床疗效.方法:自2004年3月至2008年3月,应用后路经椎弓根通道椎体内植骨椎弓根螺钉内固定加保留棘突全椎板减压自体髂骨椎管重建治疗胸腰椎严重爆裂性骨折患者10例,男7例,女3例;年龄24～58岁,平均41岁.术后通过Frankel分级与影像学检查评价手术疗效.结果:10例患者均获随访,时间1～4年,平均37个月.椎弓根螺钉无松动,无断钉、断棒,伤椎椎体前缘高度从术前(21.00±12.00)%恢复至术后(95.00±4.20)%,后缘高度从术前(70.00±15.00)%恢复至术后(96.00±3.20)%,差异有统计学意义(P＜0.01).Cobb角从术前(32.80±8.20)°恢复至术后(4.20±1.60)°,差异有统计学意义(P＜0.01).Frankel分级除1例A级者外,其余均有1级以上改善.腰痛按Denis分级评估:P1 4例,P2 4例,P3 1例,P4 1例.结论:采用后路经椎弓根通道椎体内植骨椎弓根螺钉内固定加自体髂骨椎管成形是治疗严重胸腰椎爆裂性骨折的有效方法,具有操作简单,疗效好,保留后柱结构等优点,值得临床推广使用.

Treatment of serious burst thoracolumbar fracture with posterior pedicle screw fixation,transpedicular bone grafting and vertebral canaloplasty

Objective: To study the clinical results of posterior pedicle screw fixation,transpedicular bone grafting and vertebral canaloplasty with ilium autografting in treating serious burst thoracolumbar fracture. Methods: From March 2004 to March 2008,10 patients with serious burst thoracolumbar fracture,including 7 males and 3 females with age for 24-58 years(mean 41 years)were treated by posterior pedicle screw fixation,transpedicular bone grafting and total laminectomy with preservation of spinal process and vertebral canaloplasty with ilium autografting. The operative effects were assessed according to Frankel classification and radiologic results. Results: All patients were followed up from 1 to 4 years. There was no loosening or broken in instrumentation. The anterior edge height of the fractured vertebrae body was restored from (21.00±12.00)% to (95.00±4.20)%,and the posterior edge height of the fractured vertebrae body was restored from (70.00±15.00)% to (96.00±3.20)% postoperatively,which both demonstrated improvement compared with preoperative instance(P<0.01). The Cobb angle was restored from(32.80±8.20)° to(4.20±1.60)° which also demonstrated improvement compared with the preoperative Cobb angle(P<0.01). At least one grade recovery was observed in all cases except one patient with preoperative Frankel A degree. The result of Denis classification,P1 had 4 cases,P2 had 4,P3 had 1,P4 had 1. Conclusion: Posterior pedicle screw fixation,transpedicular bone grafting and vertebral canaloplasty can obtain satisfactory results treating serious burst thoracolumbar fractures. It is a feasible method with advantages of simple operation,good efficacy,preservation of structure of posterior column which should be applied clinically.