后路椎间植骨融合联合椎弓根钉内固定选择性治疗合并椎间盘损伤的胸腰椎骨折脱位

Posterior interbody bone fusion and transpedicular screw internal fixation for selective treatment of thoracolumbar fracture dislocation complicated with intervertebral disc injury

摘要:

目的：探讨后路椎间融合器椎间植骨融合联合椎弓根钉系统内固定选择性治疗合并严重椎间盘损伤的胸腰椎骨折脱位的临床疗效。方法：2005年1月-2011年3月，后路应用椎间融合器椎间植骨融合联合椎弓根钉系统内固定治疗患者共26例。纳入标准：①胸腰椎单一节段骨折脱位，骨折椎体上份骨结构压缩或者爆裂程度<1/3，椎体中下份骨结构基本正常；②合并损伤节段的椎间盘损伤。评估患者的临床资料：AO分型、美国脊髓损伤协会神经功能分级、视觉模拟评分（visual analogue scale，VAS）、Bridwell椎间融合、伤椎后凸角、伤椎椎体高度。结果：AO分型：B型骨折20例，C型骨折6例。脊髓神经功能改善情况：除16例A级损伤无恢复外，其余患者均有1~2级的恢复。VAS由术前（9.00±0.76）改善至术后1周（5.18±1.43），末次随访为（0.74±0.57）。23例患者椎间植骨达到Ⅰ级愈合，另3例在末次随访时达到Ⅱ级愈合。术前伤椎高度为（84.27±5.27）%，恢复至术后1周（97.38±1.20）%，末次随访为（97.04±0.96）%。术前伤椎后凸Cobb角为（22.50±6.20）°，矫正至术后1周（2.60±1.86）°，末次随访为（3.50±2.65）°。术后4例患者出现脑脊液漏。无切口感染，未见明显椎间融合器沉陷，无内固定松动、断裂等并发症。结论：选择合适的患者，后路切除损伤的椎间盘、椎间融合器椎间植骨重建、联合椎弓根螺钉系统内固定是治疗合并椎间盘损伤的胸腰椎骨折脱位的有效方法。

Abstract:

Objective：To explore the clinical outcomes of interbody bone fusion combined with transpedicular screw internal fixation in selective treatment of thoracolumbar fracture-dislocations complicated with severe intervertebral disc injury through posterior ap－proach. Methods：From January 2005 to Marth 2011，26 patients with thoracolumbar fracture-dislocations complicated with severe in－tervertebral disc injury were treated by this method. Inclusion criteria：①thoracolumbar fracture dislocation in single segment，less than 1/3 upper parts of fractured vertebra being compressed or burst，middle and inferior parts of fractured vertebra being normal；②dam－aged segment complicated with severe intervertebral disc injury. Demogrophic data，AO classification of fracture，American Spinal In－jury Association grade of neurological status，visual analogue scale（VAS），Bridwell fusion grade，segmental height，segmental kyphosis and treatment-related complications were evaluated. Results：Based on AO classification，20 patients had type B facture and 6 had type C. Except 16 patients with grade A spinal cord function，spinal cord function of all patients improved by 1-2 degrees. VAS scores were （9.00±0.76） before operation and were （5.18±1.43） at one week post-operation and （0.74±0.57） at the last follow-up. Twenty-three patients had grade I fusion and 3 patients had grade Ⅱ fusion at the last follow-up. Height of the fractured vertebra was （84.27±5.27）% before the operation，（97.38±1.20）% at one week after the operation and （97.04±0.96）% at the last follow-up. Kyphosis angel was （22.50±6.20）° before the operation，（2.60±1.86）° at one week after the operation and （3.50±2.65）° at the last follow-up. Cerebrospinal fluid leakage occurred in 4 patients. There was no case of incision infection，cage subsidence and screw loosen or breakage. Conclusions：With the correct selection of operative indications，resection of damaged intervertebral disc through posterior approach，cage interbody bone reconstruction and transpedicular screw internal fixation are effective methods in treating thora－columbar fracture-dislocations complicated with intervertebral disc injury.