椎弓根螺钉治疗胸腰椎爆裂性骨折

目的探讨椎弓根螺钉在胸腰椎爆裂性骨折治疗中的疗效。方法回顾性分析2002年以来应用椎弓根螺钉的治疗45例胸腰椎骨折患者资料。全部患者采用后路椎管减压,椎体植骨加椎弓根螺钉内固定治疗。结果全部病例得到随访,平均20个月(6～60个月),其中18例脊髓不全损伤患者Frankel分级提高l～3级(平均2级)。A级10例有2例恢复到B级,1例恢复到C级,其余患者部分术后感觉平面下降或下肢感觉部分恢复,运动功能无明显改善。术后遗留轻度腰背痛3例,1例螺钉松动,无一例发生感染。随访病例均行X线片检查,后凸角由术前平均25°(11°～35°)矫正到术后10°(0°～15°),椎体前缘高度矢状径指数术前30°(15°～55°),恢复到术后85°(72°～100°)。结论后路椎管减压,椎体植骨加椎弓根螺钉内固定治疗胸腰椎爆裂性骨折是一种较理想的手术方法。此方法操作简单、安全,在解除神经及硬膜囊压迫的同时扩大了椎管,杜绝了继发性椎管狭窄,增加了脊柱稳定性,值得推广。

Pedicle screw fixation in treatment of burst fracture of thoracolumbar vertebra

Objective To observe therapeutic efficacy of pedicle screw fixation in treating burst fracture of thoracolumbar vertebra.Methods 45 patients diagnosed burst fracture of thoracolumbar vertebra were cured by pedicle screw fixation since 2002.Results For average 20 months(6-60 months)following up,satisfactory recovery of vertebral body's altitude,ideal correction of Cobb's angle were observed.Average 2(1-3)grade recover was observed in 18 cases with pero-damage of spinal cord.Among 10 cases of pre-operative A degree,2 cases were recovered to B degree,1 case to C degree according to Frankel classification and no remarkable recoveries was observed in the other cases.Only 3 cases remained tiny lumbodorsal pain after operation,and 1 case of loosening of screw was detected.Also no infections was detected.Conclusions It is an ideal operation for pedicle screw fixation to treat burst fracture of thoracolumbar vertebra.It is a simple and safe operative technique to entirely decompress in duramater and nerve roots and enlarge bore of vertebral canal,therefore eliminating secondary spinal stenosis,also increase spinal stability.