复杂胸腰椎骨折的伤椎形态特点与伤椎置钉技术

目的 分析复杂胸腰椎骨折的伤椎形态特点及伤椎置钉技术.方法 回顾性分析2005年1月至2007年12月收治并获得随访的61例AO分型为B型或C型的胸腰椎骨折患者的临床资料.其中男性53例,女性8例;年龄9～65岁,平均33.2岁.ASIA脊髓损伤分级:A级41例,B级5例,C级5例,D级6例,E级4例.受伤部位:胸椎13例,胸腰段39例,腰椎9例.分为伤椎置钉组32例和非伤椎置钉组29例.分析伤椎形态特点,并在X线片测量基础上比较两组病例在术前、术后及终末随访后凸角度、伤椎前后缘高度比、伤椎移位比的矫正与丢失;Denis评分比较两组局部疼痛和工作状态恢复的差异.结果 患者均获随访,随访时间1.5～4.5年,平均3.0年.两组在矫正角度丢失、伤椎前后缘高度比丢失、矫正伤椎移位比例、Denis疼痛评分方面差异均有统计学意义(P＜0.05),伤椎置钉组优于非伤椎置钉组.结论 运用伤椎置钉技术,可以很好地纠正脊柱骨折脱位,维持术后脊柱的稳定性.

Morphological features of complicated thoracolumbar fractures and the fixation technology of injured vertebra

Objective To study the morphological feature of complicated thoracolumbar fractures and the fixation technology of injured vertebra. Methods From January 2005 to December 2007, 61 patients with type B and C thoracolumbar fractures according to AO classification were treated. There were 53 males and 8 females, with a mean age of 33.2 years(range, 9 to 65 years). Based on ASIA grading system of neurologic deficit, Grade A was found in 41 cases, grade B in 5 cases, Grade C in 5 cases, Grade D in 6 cases and Grade E in 4 cases. The injured vertebra located at thoracic region in 13, thoracolumbar in 39 and lumbar in 9 cases. The patients were divided into two groups: 32 cases with pedicle screws in the injured vertebra and 29 cases without pedicle screw in the injured vertebra. The analyses on the morphological features of injured vertebra were performed, and comparisons were carried out on the outcome regarding the reduction and correction of the injured vertebra, and the difference of Denis scale in pain domain and work status domain, between the two groups. Results All the patients were followed up for an average of 3 years (range, 1.5 to 4.5 years). There were significance statistical difference in the correction loss of Cobb angle, sagittal index, correction of dislocation index, and the Denis pain scale between the two groups(P＜0. 05). A better outcome was observed in the injured vertebra fixation group than the injured vertebra nonfixation group. Conclusions Inserting pedicle screws in the injured vertebra is effective and useful in the correction of complicated thoracolumbar fractures. It improves biomechanical stability of the spine after the operation.