伤椎椎弓根螺钉固定横突间植骨治疗胸腰段爆裂骨折

目的评价经伤椎行椎弓根螺钉固定结合横突间植骨治疗胸腰椎单节段椎体爆裂性骨折的临床疗效。方法回顾性分析我院2006年6月至2009年1月期间经伤椎行椎弓根螺钉固定结合横突间植骨治疗胸腰椎爆裂性骨折病例资料16例,其中男性11例,女性5例;年龄21～68岁,平均42.4岁。收集的病例均为单节段椎体爆裂性骨折,伤椎仅一侧椎弓根置钉,即五钉固定法。比较术前术后椎体前缘高度、脊柱后凸角（矢状面Cobb′s角）、椎管正中矢状径、神经功能Frankel分级等指标。结果术后随访6～24个月,平均随访10.8个月,术后均获得较好复位,高度及外形基本恢复正常,无内固定物松动、断裂等并发症,手术前后椎体前缘高度、脊柱后凸角（矢状面Cobb′s角）、椎管正中矢状径比较差异均有统计学意义（P〈0.05）,疼痛明显减轻,神经功能Frankel分级亦有改善。结论经伤椎行椎弓根螺钉固定结合横突间植骨治疗胸腰椎椎体爆裂性骨折可获得不错疗效,可以较好重建椎体高度,减少并发症,增强固定的稳定性及抗扭转能力,是治疗胸腰段椎体爆裂性骨折一种可行、有效的方法 。

Treatment of Thoracolumbar Vertebra Burst fracture by Posterior Pedicle Screw System at the Injured Level Plus Bone Graft among Processus Transversus

Objective To evaluate the clinical outcome of the treatment of thoracolumbar vertebra burst fracture by posterior pedicle screw system at the injured level plus bone grafting among processus transversus.Methods Clinical data of 16 cases of thoracolumbar vertebra burst fracture from June 2006 to January 2009 were retrospectively analyzed,among them 11 were male and 5 were female,age ranged 21～68 years（average 42.4 years）.All of cases were single segment fractures,and the screw was placed only one side pedicle in the injured vertebral.There were five screws total.To compare the average height of anterior border,the average of Cobb＇s angle,the percentage of midsagital diameter and Frankel neurological function classification between before and after operation.Results The 16 patients were follwed up for 6～24 months（average 12.1 months）.The height and the shape of fracture vertebral body recovered to nearly normal size and the fusion of bone grafting among processus transversus was fine.The internal fixation didn＇t loose and break.There was no loss of correction and other complications.The average height of anterior doder,the average of Cobb＇s angle and the percentage of midsagital diameter were showed significant difference（P〈0.05）before and after operation.All patients＇ pain relieved distinctly and Frankel neurological function classification also acquired amelioration.Conclusion The treatment of thoracolumbar burst fracture by posterior pedicle screw system at the injured level plus bone grafting among processus transversus is a feasible method with satisfying curative effect.The method can not only recover height of fracture vertebral body betterly,reducing complications,but also increase the stability of spine and impove ability to resist rotation.Therefore it is an effcctive method of treating thoracolumbar vertebral burst fracture.