陈农　周海林　周凯华　高如峰　刘佐庆

(复旦大学附属中山医院青浦分院骨科，上海　201700)



·论著·

后路短节段固定结合经伤椎椎弓根植骨治疗胸腰椎骨折

陈农周海林周凯华高如峰刘佐庆

(复旦大学附属中山医院青浦分院骨科，上海201700)

摘要目的： 探讨后路短节段固定结合经伤椎椎弓根植骨治疗胸腰椎骨折的临床疗效。方法： 回顾分析2011年6月—2013年6月收治的30例胸腰椎骨折患者的临床资料，均采用后路短节段固定结合经伤椎椎弓根植骨治疗。记录手术时间，术中出血量，术前及术后疼痛视觉模拟评分，伤椎前、后缘高度比值，Cobb角，神经功能恢复(Frankel分级)及并发症情况。结果： 术后所有患者随访6～23个月，平均14.6个月。末次随访时视觉模拟评分与术前比较差异有统计学意义(P<0.05)。术后3 d及末次随访时伤椎前、后缘高度比值和Cobb角与术前比较均有明显改善(P<0.05)，术后3 d伤椎前、后缘高度比值和Cobb角和末次随访时比较差异均无统计学意义(P>0.05)。神经功能损伤的患者术后Frankel分级均有明显改善。末次随访时无内固定松动、断裂和脱出。结论： 后路短节段固定结合经伤椎椎弓根植骨能充分恢复伤椎的高度，更好地重建椎体解剖形态、矫正后凸畸形、维持矫正效果和避免长期腰背疼痛发生，该手术方法安全有效。

关键词胸腰椎骨折;椎弓根固定;椎弓根植骨

Posterior Short Segment Pedicle Screw Fixation Combined with Transpedicular Intracorporeal Grafting in Treatment of Thoracolumbar Fractures

CHENNongZHOUHailinZHOUKaihuaGAORufengLIUZuoqing

DepartmentofOrthopedics,QingpuBranchofZhongshanHospital,FudanUniversity,Shanghai201700,China

AbstractObjective： To evaluate the clinical efficacy of posterior short segment pedicle screw fixation combined with transpedicular intracorporeal grafing in the treatment of thoracolumbar fractures.Methods： The clinical data of 30 patients with thoracolumbar fractures, who were admitted and treated with posterior short segment pedicle screw fixation combined with transpedicular intracorporeal grafting during June 2011 and June 2013, were retrospectively analyzed.The operation time,intra-operational bleeding amount, preoperative and postoperative visual analogue scale(VAS) score,the ratio of anterior and posterior vertebral height, Cobb angle, neurological function(Frankel grade) and complications were recorded. Results： All the cases had been followed up for 14.6 months averagely(range from 6 to 23 months).There was significant difference between the VAS score at the last follow-up and the preoperative one (P<0.05).The ratio of anterior and posterior vertebral height as well as the Cobb angle improved significantly at the 3rdday after operation and the last follow-up as compared with preoperative ones(P<0.05). The ratio of anterior and posterior vertebral height as well as Cobb angle at the 3rdday after operation was not significantly different from that at the last follow-up(P>0.05).The postoperative Frankel grade in patients with neurological function damage improved significantly.There was no breakage or loosening happened with the internal fixation.Conclusions： The posterior short segment pedicle screw fixation combined with transpedicular intracorporeal grafting can reconstruct vertebral body height, rebuild anatomic form of vertebra, obtain better kyphosis correction,maintain the correction effect and avoid the long term lumbago and back pain.This surgical method is safe and effective.

Key WordsThoracolumbar fractures;Pedicle screw fixation;Transpedicular intracorporeal grafting

胸腰段骨折在脊柱骨折中最常见，占脊柱骨折的50%以上。后路椎弓根螺钉内固定是最常用的手术方法，但短节段跨伤椎四钉固定术后常出现内固定失败与矫正度丢失等并发症，明显影响临床疗效[1-3]，而长节段固定虽可明显提高固定疗效，但由于术中固定了更多的脊柱功能单位，现主要用于胸腰椎安全带损伤或骨折脱位型损伤[4]。……