胸腰椎爆裂性骨折经骨折椎椎弓根直接复位固定可行性研究

目的探讨经骨折椎椎弓根直接复位固定治疗胸腰椎爆裂性骨折的临床疗效。方法对2007年1月~2010年1月在我院就诊的70例胸腰椎爆裂性骨折患者应用经骨折椎椎弓根直接复位固定治疗,术后常规抗感染等对症治疗,观察手术的疗效。结果术后随访6~24个月,平均15个月;均无椎弓根钉拔出发生。复查X线及CT示伤椎高度恢复,矢状位生理曲度恢复,无脊柱侧弯。伤椎前缘高度术前（15.1±0.2）mm,术后（32.5±0.4）mm。后缘高度由术前（88.0±1.1）mm提高到（94.0±2.0）mm;后凸角由术前（21.0±1.0）°降低到术后（6.1±0.3）°,术后较术前有显著变化（P〈0.05）。神经功能恢复按Franka1分级术后较术前有不同程度的恢复。2例患者术后出现一侧下肢神经根刺激症状,经对症、脱水、应用激素及营养神经等处理,症状逐渐减轻,3个月后症状基本消失。结论经骨折椎椎弓根直接复位固定治疗胸腰椎爆裂性骨折是可行的,不会影响椎体内骨折块的复位,可以提供良好的三点固定,减少后凸的形成,增加稳定性,有利于伤椎形态的恢复,分散钉杆连接的应力,明显改善椎体成角、椎体压缩率及椎管占位率,具有较好的手术效果,值得推广。

Thoracolumbar burst fracture of vertebral fractures by direct fixation of pedicle feasibility study

Objective To investigate the efficacy of direct reduction fracture pedicle fixation for thoracolumbar burst fracture.Methods 70 cases of thoracolumbar burst fractures were treated by direct fracture of pedicle fixation treatment postoperative infection from January 2007 to January 2010,conventional anti-symptomatic was used after treatment,and observed the surgery effect.Results The patients were followed up 6 to 24 months;no pedicle screw was pulled out.X ray and CT showed reviewed vertebral height restoration,sagittal lordosis restoration,no scoliosis.Preoperative anterior vertebral height was(15.1±0.2) mm,which of postoperative was(32.5±0.4) mm.Posterior height was from preoperative(88.0±1.1) mm to(94.0±2.0) mm;kyphosis angle decreased from preoperative(21.0±1.0)° to postoperative(6.1±0.3)°.Neurologic recovery graded by Franka1 was different from that before the restoration.2 patients after the operation side of the lower extremity nerve root irritation,the symptomatic,dehydration,and nutritional nerve of hormone treatment,symptoms gradually reduced,3 months later the symptoms disappeared.Conclusion Direct reduction fracture pedicle fixation of thoracolumbar burst fracture is feasible,can not affect the block of vertebral fracture reduction,can provide a good three-point fixed,and further reduce the formation of kyphosis,increase stability,and it is worth of promotion.