间接复位治疗胸腰椎爆裂型骨折术后椎管重塑形

目的观察后路椎弓根螺钉间接复位术后椎管形态面积的变化,探讨间接复位效果及术后椎管重塑形现象。方法 2003年5月～2010年9月,同组医师采用后路椎弓根螺钉间接复位治疗胸腰椎爆裂型骨折27例,其中L113例,L29例,L34例,T121例。美国脊髓损伤学会（American Spinal Injury Association,ASIA）分级D级13例,E级14例。术前、术后1周及术后1年取内固定行CT检查,测量伤椎平面的椎管面积及伤椎相邻上下椎管平均面积,计算伤椎椎管骨块占位率。比较术前、术后1周及术后1年椎管骨块复位程度。结果 27例患者均获得随访,13例术前D级患者均恢复到E级。术后1周CT复查显示椎管骨块占位率由术前（30.9±13.8）%减至（10.4±6.4）%,差异有统计学意义（P〈0.05）;术后1年椎管骨块占位率减至（6.3±3.9）%,与术后1周相比差异有统计学意义（P〈0.05）。结论后路椎弓根螺钉间接复位治疗胸腰椎爆裂型骨折能明显有效减少椎管内骨块占位率,经过术后1年重塑形椎管面积接近正常水平。

Remodeling of the spinal canal after indirect reduction of burst vertebral fractures

Objective To discuss the effect of indirect reduction and remodeling by observing areal changes of the spinal canal after indirect reduction of thoracolumbar burst fractures.Methods From May 2003 to September 2010,a total of 27 patients with thoracolumbar burst fracture were treated with pedicle screw fixation and indirect reduction by the same surgery group.All cases were followed up to remove internal fixation 1 year after surgery.By the American Spinal Injury Association(ASIA) evaluation system,the severity of spinal cord injury was rated as grade D in 13 cases,as grade E in 14 cases.The ratio of cross-sectional area of spinal canal at the injury level to that at the adjacent level on CT scans were measured preoperatively,1 week postoperatively and 1 year postoperatively and analyzed by paired Student’s t test at the follow-up time of remodeling.Results The ASIA evaluation improved to grade E in 13 cases as grade D,initial 14 cases as grade E did not deteriorate.CT scans demonstrated that the bone fragment occupation of cross-sectional area of injured segment was decreased from preoperative(30.9±13.8)% to(10.4±6.41)% 1 week after surgery,the difference was statistically significant(P<0.05);and the occupation was decreased to(6.3±3.9)% 1 year after surgery,with statistical difference(P<0.05).Conclusion The decompression of spinal canal is effective with pedicle screw fixation and indirect reduction on the management of thoracolumbar burst fractures.The area of injured canal can be close to the normal by the remodeling after 1 year postoperatively.