后路减压过伸体位复位椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折临床疗效分析

目的：分析后路减压、过伸体位复位、椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折的临床疗效。方法：采用后路减压、过伸体位复位、椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折患者48例。手术前后测量骨折椎体前、后缘高度百分比、后凸畸形Cobb＇s角,定期随访并评定神经功能恢复情况。结果：术后伤椎椎体前缘高度及后凸畸形Cobb＇s角明显恢复（t=9.26,P〈0.01;t=7.35,P〈0.01）,伤椎后缘高度较术前无明显变化（t=8.32,P〉0.05）。随访6～36个月,平均25个月,患者平均伤椎后凸畸形Cobb＇s角及椎体前缘高度分别较术后丢失5%和8%。5例完全神经损伤者（Frankel A级）神经功能无明显恢复,24例不完全神经损伤者（Frankel A～D级）中21例（87.5%）神经功能恢复1级或以上。断钉1例,钉道松动1例,过度牵伸复位致神经损伤加重1例。结论：后路减压、过伸体位复位、椎弓根钉棒系统内固定治疗胸腰椎爆裂性骨折,能有效恢复椎体高度和生理弯曲,有利于恢复神经功能,但也存在断钉、钉道松动、伤椎高度及矫正角度丢失等问题。

Analysis of the clinical effect of posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system on burst thoracolumbar fracture

Objective:To study the clinical effect of posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system on burst thoracolumbar fracture.Method:48 patients with burst thoracolumbar fracture were treated with posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system.The heights of anterior and posterior border and kyphosis Cobb's angle of compressed vertebral bodies were measured before and after surgery.All patients were followed up regularly and the state of neurofunctional recovery was evaluatd.Results:The heights of anterior border and kyphosis Cobb's angle of compressed vertebral bodies restored obviously after surgery(t=9.26,P＜0.01;t=7.35,P＜0.01) and the heights of posterior border presented no obvious change after surgery (t=8.32,P＞0.05). The average follow-up period was 25 months(7-36 months) and the value of loss of mean height of anterior border and kyphosis Cobb's angle of compressed vertebral bodies were 5% and 8%,respectively. The neurofunction of 5 patients(Frankel A grade) didn't recover,while improvement of neurofunction at least 1 Frankel grade was found in 21 patients(Frankel A-D grade).Break of screw occurred in one case and loose of screw occurred in another case and damage of neurofunction aggravated in one case due to excess drawing.Conclusion:The method of posterio decompression and reduction in hyperextension body position and internal fixation with pedicle of vertebral arch screw system is effective for burst thoracolumbar fracture.It provides satisfactory restoration of height of vertebral bodies and physiologic postural contour and it facilitates recovery of neurofunction.However,it is associated with troubles of break of screw and loose of screw and loss of height and kyphosis Cobb's angle of compressed vertebral bodies.