经伤椎椎弓根单侧椎弓根螺钉固定联合短节段椎弓根螺钉治疗轻中度不稳定型胸腰椎骨折

[Unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability].

作者信息

Zeng Zhi-li, Cheng Li-ming, Qian Lie, Jia Yong-wei, Yu Yan, Wang Jian-jie

机构信息

Department of Spine Surgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2012 Mar;50(3):234-7.

PMID:22800747

Abstract

OBJECTIVE

To evaluate the efficacy of unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw in the treatment of thoracolumbar fracture of mild to moderate instability.

METHODS

Twenty-six patients with single segment thoracolumbar fracture received unilateral pedicle screw fixation through the pedicle of fractured vertebra in combination with the short segment of pedicle screw from January 2008 to December 2009. There were 16 patients were male and 10 were female with an average age of 47.3 years (range from 39 to 60 years). Fracture severity score was constructed by using the load-sharing classification (4 points for 2 cases, 5 points for 14 cases, 6 points for 10 cases). By Frankel assessment system, 2 cases were in grade C, 3 in grade D, 21 in grade E. The assessment included anterior vertebral body height, the sagittal Cobb angle, the restoration of nervous function, visual analogue score (VAS) and Oswestry disability index (ODI).

RESULTS

The follow-up after the surgery was 13 - 26 months, with an average of 18.6 months. There were no fixation failure, defined as implant failure or ≥ 10° correction loss. The neurological status of 4 patients, who had an associated neurologic deficit preoperatively, was completely recovered. The Frankel grade of another case was re-rated D from the original C. The mean anterior vertebral body height increased from 57.0% ± 6.3% before the surgery to 93.1% ± 1.7% at the last follow-up(F = 455.276, P < 0.05). The sagittal Cobb angle decreased from 15.6° ± 4.7° before the surgery to 2.6° ± 5.2° at the last follow-up (F = 34.623, P < 0.05). VAS and ODI were 1.0 ± 0.7 and 17.0 ± 5.9 at the last follow-up.

CONCLUSION

Unilateral pedicle screw fixation through the pedicle of fractured vertebra combined with the short segment of pedicle screw is effective for thoracolumbar fracture with mild to moderate instability.

摘要

目的

评估经骨折椎弓根单侧椎弓根螺钉固定联合短节段椎弓根螺钉治疗轻至中度不稳定型胸腰椎骨折的疗效。

方法

2008年1月至2009年12月，26例单节段胸腰椎骨折患者接受经骨折椎弓根单侧椎弓根螺钉固定联合短节段椎弓根螺钉治疗。男性16例，女性10例，平均年龄47.3岁（39至60岁）。采用载荷分担分类法构建骨折严重程度评分（2分2例，5分14例，6分10例）。根据Frankel评估系统，C级2例，D级3例，E级21例。评估指标包括椎体前缘高度、矢状面Cobb角、神经功能恢复情况、视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）。

结果

术后随访13至26个月，平均18.6个月。无内固定失败，即植入物失败或矫正丢失≥10°。4例术前伴有神经功能缺损的患者神经功能完全恢复。另1例患者的Frankel分级从原来的C级重新评定为D级。末次随访时椎体前缘平均高度从术前的57.0%±6.3%增加至93.1%±1.7%（F = 455.276，P < 0.05）。矢状面Cobb角从术前的15.6°±4.7°减小至末次随访时的2.6°±5.2°（F = 34.623，P < 0.05）。末次随访时VAS和ODI分别为1.0±0.7和17.0±5.9。