经骨折椎单节段复位固定治疗创伤性胸腰椎骨折的临床疗效

目的评价经骨折椎单节段椎弓根螺钉复位固定治疗创伤性胸腰椎骨折的临床疗效。方法采用单节段椎弓根螺钉固定治疗创伤性胸腰椎骨折132例。按AO分型，A型117例，B型8例，C型7例。通过测量骨折椎楔变指数（wI）、骨折节段矢状指数（SI）评价影像学效果，并通过Oswestry功能障碍指数评价临床疗效。结果所有患者手术顺利，手术用时平均87min，术中出血量平均136ml。随访128例，平均随访时间30．4个月（11～54个月），全部骨性融合，除1例出现螺钉松动外，无内固定失败。术前骨折椎WI和S1分别为（42．96±11．51）％和13．06°±4．13°，术后WI和S1分别为（21．78±7．66）％和4．47°±2．28°，与术前比较差异具有统计学意义（P〈0．01）。除2例外，最后一次随访时未见明显矫正丢失（P〈0．05）。Oswestry功能障碍指数较术前获得明显改善（P〈0．05）。结论经骨折椎单节段椎弓根螺钉复位固定融合术具有创伤小、用时短、出血少、脊椎运动功能单位丢失减少等优点，可用于治疗部分创伤性胸腰椎骨折。

The efficacy of monosegmental pedicle screw instrumentation for traumatic thoracolumbar fractures

Objective To evaluate the clinical efficacy of monosegmental pedicle screw instrumentation（MPSI） in management of traumatic thoracolumbar fractures. Methods One hundred and thirty-two patients with traumatic thoracolumbar fractures were treated by MPSI in our department. According to AO classification, 117 cases were type A, 8 were type B and 7 were type C. Radiologic （wedge index and sagittal index） and clinical （Oswestry dysfunction index） outcomes were analyzed. Results All of the operations were performed safely. The average operative time was 87 minutes, with average estimate blood loss of 136 ml. One hundred and twenty-eight patients were followed up successfully for 11-54 months（average 30.4 months）. All the patients achieved bone fusion without implant failure except one with screw dislodgement. The preoperative wedge index and sagittal index were （42.96°±11.51° ）% and 13.06°± 4.13°respectively. The postoperative results were （21.78 7.66）% and 4.47° ± 2.28° respectively, which improved significantly （P 〈0.01）. No significant correction loss occurred during the follow-up period except in 2 patients. The Oswestry dysfunction index of all the patients during follow-up improved significantly （P 〈0.05）. Conclusions MPSI is an effective and reliable operative technique for selected traumatic thoracolumbar fractm＇es with advantages of minimal invasion, shorter operative duration, less blood loss and decreased vertebral motion segment loss.