经伤椎椎弓根植骨联合AF内固定系统治疗胸腰椎爆裂骨折高度丢失的临床疗效

目的总结治疗胸腰椎爆裂骨折的临床经验,推广其临床应用。方法 24例单椎体胸腰椎爆裂骨折病例,其中男16例,女8例;年龄20～75岁。损伤节段：T111例,T125例,L18例,L27例,L32例,L41例。伤后至手术时间3～5d,均为爆裂骨折。术前椎管占位率25%～65%。脊柱后凸程度（Cobb角）：14～35°,椎体压缩至正常的10%～55%。Frankel分级：A级2例,B级4例,C级6例,D级5例,E级7例。按置钉→减压→复位→植骨步骤进行。结果随访12～18个月,未发现继发性后突畸形,椎体高度恢复至正常的85%～100%,椎管占位率5%～15%。脊柱后凸程度（Cobb角）：平均3°,Frankel分级：A级1例,B级2例,C级2例,D级4例,E级15例。结论经伤椎椎弓根植骨联合AF内固定系统治疗胸腰椎爆裂骨折,可在早期稳定的基础上为伤椎椎体的长期稳定提供物质基础,避免因复位后＂空壳椎体＂的形成,从而减少术后并发症,有临床推广价值。

The therapeutic effect of transpedicular intracorporeal bone grafting combined with AF internal fixation on thoracolumbar burst fracture

Objective To summarize the clinical experiences in the treatment of single thoracolumbar burst fracture in order to spread its application in clinic.Methods The 24 patients(age range:20～75yr) with single thoracolumbar burst fracture were enrolled in the study,including 16 males and 8 females.Among them,there was 1 case whose injure segment was located on T11,5 cases on T12,8 cases on L1,7 cases on L2,2 cases on L3,1 cases on L4.The duration from injury to operation was 3～5 days,and all the patients were thoracolumbar burst fracture cases.The percentage of fragment in spinal canal was 25～65% before operation.The Cobb’s angle varied at 14～35°,and centrum was compressed to 10%～55% of normal one.The Frankel classification was 2 cases at grade A,4 cases at grade B,6 cases at grade C,5 cases at grade D and 7 cases at grade E.The operation was performed in the order of pedicle screw fixation → decompression →reduction→bone grafting.Results All the patients were followed up for 12～18 months,and no secondary kyphosis malformation was found.The vertebral body height was recovered to 85%～100% of normal one,and the percentage of fragment in spinal canal was 5%～15%.The average Cobb’s angle was 3°.The Frankel classification was 1 cases at grade A,2 cases at grade B,2 cases at grade C,4 cases at grade D and 15 cases at grade E.Conclusion The transpedicular intracorporeal bone grafting combined with AF internal fixation in the treatment of thoracolumbar burst fracture can provide material basis for the long-term stabilization of the thoracolumbar body of spine on the basis of early stabilization,and can avoid the formation of "empty shell centrum" because of reduction,as a result,which can reduce the incidence of complications after operation,so,which deserves more application in clinic.