椎弓根钉棒系统加植骨融合治疗胸腰椎爆裂性骨折并脊髓损伤的 临床研究

目的:探讨椎弓根钉棒系统加植骨融合治疗胸腰椎爆裂性骨折并脊髓损伤的疗效。方法:回顾性分析2010年3月至2014年12月,采用椎弓根钉棒系统加植骨融合治疗93例胸腰椎爆裂性骨折并脊髓损伤患者的资料,男56例,女37例。致伤原因:交通事故伤27例,高处坠落伤47例,重物压伤19例。骨折节段:L1骨折22例,L2骨折16例,L3骨折6例,T11骨折15例,T12骨折34例。结果:本研究共93例患者,所有患者经过一般12个月的随访,其中平均随访13.8月(10-16月)。与术前相比,患者术后6个月伤椎前缘高度比值明显增加,Cobb角值和椎管占位率明显降低(t=6.167,7.241,7.143,P0.05)。术后12个月伤椎前缘高度比值明显增加,Cobb角值和椎管占位率明显降低(t=9.345,11.541,11.263,P0.05)。且患者术后12个月与术后6个月在伤椎前缘高度比值、Cobb角、椎管占位率上比较,差异具有统计学意义(t=9.632,8.154,7.415,P0.05),根据Frankel神经分级,术后大部分患者神经功能有所恢复。其中,Frankel分级为A的患者有35例恢复,术后有效恢复率为87.5%;B级患者有25例恢复,术后有效恢复率89.3%。C级和D级患者术后有效恢复率均为100%,B,C,D级患者与A级患者有效恢复率相比,差异没有统计学意义(x~2=0.051,2.196,1.253,P0.05),随访12个月期间,2例患者术后5个月出现内固定物松动,1例术后12个月发生螺钉断裂,其余患者无伤口感染、肺部感染、深静脉血栓等并发症发生。结论:椎弓根钉棒系统加植骨融合能有效治疗胸腰椎爆裂性骨折并脊髓神经损伤,术后患者神经功能恢复较好,并发症较少,值得临床推广使用。

The Efficacy of Pedicle Screw Fixation and Bone Fusion in the Treatment of Thoracolumbar Burst Fracture with Spinal Cord Injury

Objective:Discuss the efficacy of pedicle screw fixation and bone fusion in the treatment of thoracolumbar burst fracture with spinal injury.Methods:Retrospective analysis from March 2010 to December 2014, 93 patients with thoracolumbar burst fracture and spinal injury were selected, male 56 cases, female 34 cases. Cause of injury: 27 cases of traffic accident injury, 47 cases of falling injury, 19 cases of heavy load pressure. Fracture segment: 22 cases of L1 fracture, 16 cases of L2 fracture, 6 cases of L3 fracture, 15 cases of T11 fracture, 34 cases of T12 fracture.Results:There were 93 patients in this study. All patients were followed up for 12 months, the average follow-up was 13.8 months(10-16 months). Compared with the value before surgery, the value of vertebral height ratio was increased, the Cobb''s angle and canal occupying rate were decreased apparently after 6 months surgery (t=6.167, 7.241, 7.143, P<0.05). the value of vertebral height ratio was increased, the Cobb''s angle and canal occupying rate were decreased apparently after 6 months surgery(t=9.345, 11.541, 11.263, P<0.05). There were significantly difference on these indexes between the values after 6 months and 12 months surgery (t=9.632, 8.154, 7.415, P<0.05). The Frankel nerve function aspect, 35 cases of GradeA recovered after surgery. So the postoperative effective recovery rate of Grade A patients was 87.5%. 25 cases of Grade B recovered after surgery. So the postoperative effective recovery rate of Grade B patients was 89.3%. Besides, the The postoperative effective recovery rate of Grade C and D was 100%. There were no statistical significance on the effective recovery rate between Grade A patients and Grade B, C, D patients(x2=0. 051, 2.196, 1.253, P>0.05). After 12 months follow-up, there were no wound infection, pulmonary infection, deep venous thrombosis and other complications happened.Conclusion:Pedicle screw fixation and bone fusion had a good therapeutic effect on the thoracolumbar burst fracture with spinal injury. The nerve function recovered well and the complications was less. It was worthy of clinical application.