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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, P＜0.05)。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, P＜0.05)。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, P＜0.05)，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 (x2=0.051, 2.196, 1.253, P>0.05)，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。

英文摘要:

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.

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