椎间盘疝入胸腰段骨折椎体导致骨折畸形愈合及椎间隙高度下降

目的：分析损伤且疝入胸腰段骨折椎体的椎间盘组织对骨折愈合、椎体骨缺损体积变化及椎间隙高度影响的临床特点。方法：自2016年4月至2020年4月，行椎弓根钉棒系统复位内固定治疗140例胸腰段单椎体骨折合并上邻椎间盘损伤患者，男83例，女57例，年龄19~58（39.33±10.26）岁。术后6、12、18个月定期门诊复诊随访。损伤椎间盘组织未疝入骨折椎体患者为对照组，椎间盘损伤且疝入骨折椎体患者为观察组。通过不同回访时间下胸腰段正侧位X线片、CT及MRI扫描图像，分析计算骨折椎体楔变角、矢状位后凸角和上邻椎间隙高度变化，椎体复位后骨折愈合及骨缺损体积的变化以及椎间盘退变等级变化；并通过视觉模拟评分（visual analogue scale，VAS）、日常生活功能障碍指数（Oswestry disability index，ODI）评估患者预后；最后综合分析不同组别之间上述结果的差异性。结果：所有患者术后伤口正常愈合，无并发症发生。共87例患者获得完整回访资料，至少回访至内固定术后18个月。胸腰段正侧位X线发现观察组患者在复位内固定手术18个月后，椎体楔变角、矢状位后凸角增加及上邻椎间隙高度下降均大于对照组（P<0.05）。CT扫描发现观察组患者椎体复位术后12个月骨折畸形愈合并形成与椎间隙相通的骨缺损"空腔"，且其体积较前明显增大（P<0.05）。MRI扫描发现术后12个月观察组损伤椎间盘退变率较对照组严重且差异具有统计学意义（P<0.05）。但各时间下腰背部疼痛VAS及ODI差异无统计学意义。结论：损伤椎间盘组织疝入骨折椎体，使骨折周围骨质吸收骨缺损体积增大，形成与椎间隙相通的畸形愈合"空腔"，这可能是内固定装置去除后椎体楔变角、矢状面后凸角增加和椎间隙高度下降的主要原因。     

后路椎弓根螺钉固定加经椎弓根注射型硫酸钙植骨治疗胸腰椎爆裂性骨折

目的观察经椎弓根注射型硫酸钙植骨对预防胸腰椎爆裂性骨折椎弓根钉固定失败的作用及意义。方法本组66例胸腰椎爆裂性骨折患者随机分成2组：A组（行短节段内固定并辅助经椎弓根注射型硫酸钙植骨）33例,B组（仅行短节段内固定）33例。平均随访16个月,在侧位X线片上测量Cobb角、伤椎后凸角以及伤椎相对高度,功能评定采用Greenough腰痛评分法（lowback outcome score,LBOS）。结果手术前、后2组间Cobb角、伤椎后凸角以及伤椎相对高度差异无统计学意义（P〉0．05）,而末次随访2组问Cobb角、伤椎后凸角以及伤椎相对高度差异有统计学意义（P〈0．01）。LBOS评分,A组优良率为85％（28／33）,B组仅为60％（20／33）。结论经椎弓根注射型硫酸钙植骨是降低内固定失败、减少伤椎高度丢失、后凸畸形等并发症的有效措施。     

Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures

BackgroundShort-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate. We investigated the clinical and radiological results of temporary short-segment pedicle screw fixation without augmentation performed for thoracolumbar burst fractures with the goal of avoiding treatment failure by waiting to see if anterior reconstruction was necessary.MethodsWe studied 27 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws and without augmentation. Implants were removed approximately 1 year after surgery. Neurological function, kyphotic deformity, canal compromise, fracture severity, and back pain were evaluated prospectively.ResultsAfter surgery, all patients with neurological deficit had improvement equivalent to at least 1 grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and maintenance of the reduced vertebra was successful even without vertebroplasty, regardless of load-sharing classification. Therefore, no patients required additional anterior reconstruction. Postoperative correction loss occurred because of disc degeneration, especially after implant removal. Ten patients had increasing back pain, and there are some correlations between the progression of kyphosis and back pain aggravation.ConclusionTemporary short-segment fixation without augmentation yielded satisfactory results in reduction and maintenance of fractured vertebrae, and maintenance was independent of load-sharing classification. Kyphotic change was caused by loss of disc height mostly after implant removal. Such change might have been inevitable because adjacent endplates can be injured during the original spinal trauma. Kyphotic change after implant removal may thus be a limitation of this surgical procedure.     

Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation

OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 +/- 4.06%; Group B, -6.17 +/- 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 +/- 7.9 degrees) than in Group B2 (16.8 +/- 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.     

CYL脊柱内固定器治疗胸腰段爆裂骨折疗效评价

目的 评价CYL脊柱内固定器后路短节段内固定治疗无神经损伤的单节段胸腰段爆裂骨折疗效.方法 回顾分析2007年9月至2009年12月74例无神经损伤的单节段胸腰段爆裂骨折(Denis爆裂骨折A、B、C型)患者资料,男性53例,女性21例,年龄(18 ～64)岁,平均(39±15)岁.所有患者均行后路短节段内固定,未直接减压,亦未植骨融合.比较术前、术后、拔钉前及末次随访椎体前高压缩率、椎体楔形角、Cobb角、局部后凸角、腰椎疼痛及功能评分变化情况;记录切口感染、断钉、医源性脊髓损伤发生情况.结果 随访14～ 38个月,平均(20±11)个月.Cobb角矫正丢失明显,为9.8°±5.1°,局部后凸角矫正丢失为9.1°±4.8°,差异均具有统计学意义(t=2.48和3.41,P＜0.05);椎体前高压缩率、椎体楔形角变化差异无统计学意义(P＞0.05).术前Cobb角≤20°与术前Cobb角＞20°的患者比较,末次随访时疼痛较轻(优良率98.3％比86.7％,x2=4.16,P=0.04),功能更佳(优良率88.1％比66.7％,x2=24.34,P＜0.01).手术切口感染1例,断钉1例,螺钉松动1例,无医源性脊髓损伤病例.结论 CYL脊柱内固定器后路短节段固定治疗无神经损伤的单节段胸腰段爆裂骨折,影像及临床结果满意,可作为一种安全可靠的治疗选择.     

椎弓根螺钉固定结合可注射型人工骨治疗严重腰椎爆裂性骨折

目的 探讨应用椎弓根螺钉固定结合可注射型人工骨(MIIG)治疗严重腰椎爆裂性骨折的临床疗效. 方法 自2002年3月至2004年1月,采用此方法治疗严重腰椎爆裂性骨折患者38例,Denis分型:A型5例,B型16例,c型8例,D型3例,E型6例.观察手术前后后凸畸形、椎体前后缘高度变化、腰背疼痛VAS评分、神经功能分级,并行单因素方差统计分析. 结果 所有患者获得18～36个月(平均26个月)随访.骨折椎体近似解剖复位34例,椎体高度恢复4/5者4例,手术前后Cobb角、椎体前缘高度、腰背疼痛VAS评分手术前、后均存在明显差异(P<0.05),术后均无神经症状加重或出现新的神经症状,未见人工骨灌注后造成椎管渗漏,随着新骨的长入MIIG逐步完全被新骨替代.全部骨性愈合,无断钉、断棒、退钉及松动现象.于术后10～15个月取出内固定,骨折椎体未发生再塌陷,仅2例遗留腰背痛. 结论 严重腰椎爆裂性骨折应用椎弓根螺钉固定结合可注射型人工骨治疗可减少椎体高度、角度丢失及纠正后凸畸形,减轻腰背疼痛,手术安全性高,疗效确切.     

Radiographic parameters for evaluating the neurological spaces in experimental thoracolumbar burst fractures

It is important to know the condition of neural spaces during the nonoperative treatment of thoracolumbar burst fractures. The goals of the current study were to identify the correlation between the degree of deformity of a fractured vertebra and the encroachment of neural spaces, and to determine how the encroachment and the deformity can be improved by the extension posture simulating the postural reduction. Experimental burst fractures were produced in L1 vertebrae of nine human thoracolumbar spine segments (T11-L3) with neural spaces lined with tiny steel balls. Lateral radiographs were taken in neutral and extended posture before and after the trauma. Anterior vertebral height, posterior vertebral height, vertebral height ratio, vertebral kyphotic angle, posterior vertebral body angle, and the cross diagonal angle were the geometric parameters used to describe the vertebral deformity. The canal diameter and superior and inferior intervertebral foramen areas were defined as the neural spaces. All parameters were measured on the scanned images of radiographs, as seen on the computer screen. Among the vertebral body parameters, the posterior vertebral height, posterior vertebral body angle, and cross diagonal angle showed significantly higher correlations with the canal encroachment. The extended posture did not improve the canal and intervertebral foramen encroachments. The kyphotic deformity (vertebral kyphotic angle and anterior vertebral height) was improved but the deformity of the vertebral posterior wall (posterior vertebral height and posterior vertebral body angle) was not improved because of the extended posture.     

经椎弓根椎体内植骨治疗胸腰椎爆裂骨折

目的探讨经椎弓根椎体内植骨治疗胸腰椎爆裂骨折的临床疗效。方法治疗组新鲜爆裂骨折16例,男11例,女5例;年龄19~59岁,平均43岁;经椎弓根椎体内植骨,结合短节段椎弓根螺钉系统固定治疗。对照组胸腰椎新鲜爆裂骨折36例,男25例,女11例;年龄21~63岁,平均41岁;单纯用短节段椎弓根螺钉系统固定治疗。两组均于术前、术后及术后1年行X线检查,测量矢状面指数和椎体前缘压缩百分比,并对结果行统计学分析。结果治疗组在纠正局部后凸(矢状面指数),恢复椎体前缘高度(椎体前缘压缩百分比)方面均优于对照组。结论短节段椎弓根螺钉固定和经椎弓根椎体内植骨治疗胸腰椎骨折,可重建前、中柱的稳定性,有效防止纠正度的丢失。     

经后路椎弓根截骨短节段椎弓根钉内固定治疗脊柱后凸畸形

目的探讨经椎弓根单椎体截骨短节段椎弓根钉内固定治疗脊柱后凸畸形的临床疗效。方法2001年6月~2003年11月,采用经后路椎弓根截骨短节段椎弓根钉内固定治疗16例脊柱后凸畸形患者。其中男11例,女5例,年龄24~51岁。强直性脊柱炎12例,陈旧性胸腰椎骨折脱位伴不完全截瘫2例,椎体发育不良2例。病程7~25年,平均12.8年。手术前、后均行脊柱全长X线片检查,测量胸椎后凸角、腰椎前凸角、骶骨水平角及骶骨后上角至脊柱矢状轴线的距离,评定植骨愈合情况、内固定位置及手术并发症。按Bridwell-Dewald脊柱疾患疼痛及功能评定标准进行手术前后疗效评价。结果术中出血700~2000ml,平均1100ml;术中硬脊膜破裂1例;术后发生麻痹性肠梗阻1例,下肢短暂性麻痹2例。术后获随访18~35个月,平均25.6个月。植骨愈合满意,无延迟愈合或不愈合。最后随访时,腰椎前凸角从术前9.6±16.4°,矫正至术后42.6±14.3°(P<0.05),平均矫正角度为33°;骶骨水平角的改变与此类似。胸椎后凸角手术前后改变不明显,而骶骨后上角至脊柱矢状轴线的距离由术前97.5±45.6mm降至术后10.7±9.6mm(P<0.05)。术后疼痛、工作及社交情况较术前都有明显改善。结论经后路椎弓根椎体截骨短节段椎弓根钉内固定治疗脊柱后凸畸形,矫正度数大,手术相对安全,可取得较理想的放射学矫形效果及临床疗效。     

Percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system: an analysis of 38 cases

Objective： To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study. Methods： Atotal of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation （OPSF） and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation （SPPSF）. As a method of evaluation, the incision size, the intraoperation and post- operative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb＇s angle, vertebral body angle and vertebral body height were recorded and compared. Results： All patients were followed up for 8-24 months （average 11.6 months）. There were significant differences in the incision size, surgical blood loss, surgical draining Joss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups （P〈0.05）. Mean preoperative kyphotic deformity was 16.0° and improved by 9.3° after surgery in OPSF group, but 15.2° and 10.3° respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9°and improved by 7.9° after surgery in OPSF group, but 14.9° and 6.6° respectively in SPPSF group. Mean anterior vertebral body height （% of normal） was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height （% of normal） was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0° ofkyphosis correction was lost in OPSF group, but 3.2° in SPPSF group. And 1.0°of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5°in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb＇s angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation （P〈0.05）. There were no significant differences in the postoperative sagittal Cobb＇s angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups （P〉0.05）, but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups （P〈0.05）. Conclusion： The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF.     

颗粒骨经椎弓根椎体内外植骨融合内固定治疗胸腰椎骨折

目的探讨脊柱后路颗粒骨经椎弓根椎体内外植骨短节段椎弓根钉内固定治疗胸腰椎骨折可行性。方法将70例胸腰椎骨折随机分为两组:A组(n=20)采用颗粒骨经椎弓根椎体内植骨融合短节段椎弓根钉内固定;B组(n=50)采用单纯短节段椎弓根钉内固定。对后凸畸形角度及矫正角度、椎体前缘高度以及椎管矢状径进行测量,采用Frankel功能分级和Denis疼痛分级方法进行神经功能改变的评价。结果后凸畸形术后矫正度数较术前两组均很明显。随访中,A组矫正度数的丢失明显小于B组(P=0.0001)。术后伤椎前缘高度百分比增加值两组比较有显著差异(P<0.001)。术后随访中,A组伤椎椎体前缘高度无丢失(P<0.001),B组伤椎椎体前缘高度有丢失(P<0.05)。采用Denis疼痛分级,两组术后均有很好的改善。采用Frankel功能分级,术后神经功能变化,A组患者平均提高优于B组。结论脊柱后路颗粒骨经椎弓根椎体内外植骨结合内固定治疗胸腰椎骨折植骨融合率高,能有效恢复椎体高度和防止术后矫正度丢失。     

短节段椎弓根螺钉固定联合椎体成形术治疗伴有后凸畸形Kümmell病

目的 :探讨后路短节段椎弓根螺钉内固定联合椎体成形术治疗伴有后凸畸形Kümmell病的临床疗效。方法:回顾性分析2016年1月至2018年12月采用后路短节段椎弓根螺钉内固定联合椎体成形术治疗的24例伴有后凸畸形Kümmell病患者,其中男6例,女18例,年龄63～85(73.1±6.5)岁。比较患者术前、术后3 d及末次随访时的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry Disability Index,ODI),伤椎椎体前缘高度,受累节段矢状面Cobb角等指标以评价临床疗效,并观察手术并发症。结果:所有24例患者获得随访,时间12～24(15.5±3.2)个月。VAS评分由术前的5.21±1.06下降至术后3 d的2.38±0.58以及末次随访时的1.71±0.75;ODI由术前的(50.4±13.5)%下降至术后3 d的(20.9±8.0)%以及末次随访时的(16.7±9.6)%;椎体前缘高度由术前的(8.0±4.2) mm恢复至术后3 d的(18.1±5.0) mm以及末次随访时的(16.8±5.1) mm;Cobb角由术前的(19.5±6.3)°下降至术后3 d的(7.6±2.1)°以及末次随访时的(8.4±1.7)°。术后3 d和末次随访VAS、ODI、椎体前缘高度、Cobb角较术前明显改善(P0.05)。术后出现1例无症状骨水泥渗漏,1例浅表切口感染。结论:后路短节段椎弓根螺钉内固定联合椎体成形术治疗伴有后凸畸形Kümmell病具有手术创伤相对小、临床效果优良、椎体高度恢复良好、后凸角度纠正满意、并发症少等优势,是治疗伴有明显后凸畸形Kümmell病的一种较为安全有效的手术方式。     

Posterior pedicle screw fixation with supplemental laminar hook fixation for the treatment of thoracolumbar burst fractures

Surgical treatment of thoracolumbar burst fractures with posterior short-segment pedicle fixation usually provides excellent initial correction of kyphotic deformity, but a significant amount of correction can be lost afterwards. This study evaluates the clinical relevance of the short-segment pedicle fixation supplemented by laminar hooks (2HS-1SH) construct in the surgical treatment of thoracolumbar burst fractures. Twenty-five patients with a single-level thoracolumbar burst fracture were assessed in this retrospective study. All patients were followed for a minimum of 1 year (mean 2.9 [standard deviation {SD}] 1.5 y). Preoperative vertebral height loss and local kyphosis were 35% (SD 14%) and 19° (SD 9°), respectively. Mean corrections of vertebral height and kyphosis were 10% (SD 16%) and 12° (SD 9°), respectively. Mean loss of correction at last follow-up was 2% (SD 6%) and 4° (SD 3°) for vertebral height and kyphosis, respectively. Loss of correction was significant for local kyphosis (p < 0.001) but not for vertebral height (p = 0.20). Despite the significant loss of correction for local kyphosis, it remained improved at latest follow-up when compared with the preoperative value (p < 0.001). For patients with more than 2 years of follow-up, most of the loss of correction in local kyphosis occurred during the first postoperative year. There was no evidence of instrumentation failure or pseudarthrosis in any patient. The 2HS-1SH construct provides significant correction of vertebral body height and local kyphosis. It also preserves the initial correction and minimizes the risk of instrumentation failure.     

短节段椎弓根螺钉固定结合椎体增强术治疗胸椎爆裂性骨折

目的 分析临床行短节段椎弓根螺钉固定基础上联合椎体增强术来治疗胸椎爆裂性骨折的效果.方法 收治的40例确诊为胸椎爆裂性骨折的患者C臂机作为研究对象,采用在行短节段椎弓根螺钉固定基础上联合椎体增强术来治疗胸椎爆裂性骨折,回顾分析伤椎的痊愈情况.结果 经过术后的随访3年时间的随访发现,无1例内固定失败.40例患者C臂机完全恢复,无加重神经功能损害现象.自固化硫酸钙在术后4个月得以吸收,0.5年后椎体骨折术愈合.伤椎的前缘高度和术前比较,已经由(54.50±10.89)%恢复到(86.57±7.67)%,最后维持于(93.46±8.59)%;患者的矢状面Cobb角已经由术前的(33.56±8.85)°恢复到术后的(7.97±6.38)°,最后维持于(10.76±6.98)°.Oswestry功能障碍的指数达23.6.结论 临床行短节段椎弓根螺钉固定基础上联合椎体增强术来治疗胸椎爆裂性骨折,安全简便,可有效预防椎体高度发生丢失以及近战型后凸畸形,临床效果显著,值得进一步推广使用     

Reduce the fractured central endplate in thoracolumbar fractures using percutaneous pedicle screws and instrumentational maneuvers: Technical strategy and radiological outcomes

IntroductionTraumatic thoracolumbar burst fracture is a common condition without a clear consensus on the best treatment approach. Percutaneous pedicle screw fixation (PPSF) techniques are widely used in practice, while its ability to correct fracture deformity is relatively weak, especially for the central area of the endplate. In this study, we reported a novel technique to reduce the fractured central endplate in thoracolumbar burst fractures.MethodsThe new reduction technique uses six percutaneous pedicle screws for the fractured vertebra and its adjacent vertebrae. Pedicle screws implanted in the two adjacent vertebrae were parallel to the superior vertebral endplate, as routinely required. Two monoaxial pedicle screws implanted in the fractured vertebra were placed toward the anteroinferior portion of the fractured vertebral body. After routine instrumentation and ligamentotaxis reduction, the bolt heads of the four screws implanted in the adjacent vertebrae were first tightened, and then the bolt heads of the screws implanted in the fractured vertebra were gradually tighten to elevate the collapsed endplate. A fundamental principle of this technique is to implant the pedicle screw in the fractured vertebra towards the anteroinferior portion of the vertebra in such a way that the angle between the pedicle screw and the rod is oblique on lateral fluoroscopy. As such, when the bolt heads were tightened, the pedicle screws can be swung up to reduce the endplate fragments.ResultsThe novel technique was performed in 24 patients with neurologically intact thoracolumbar AO type A3 fractures. The middle vertebral height ratio was significantly improved from 69.7%±7.6% after routine reduction to 85.1%±4.5% postoperatively (p<0.01). No complication was noticed for this new reduction technique. At 6-month follow-up, no significant correction loss of the middle and posterior vertebral height ratios, Cobb angle, and vertebral wedge angle was observed, while 5.8% of correction loss was observed for the anterior vertebral height ratio.ConclusionThe described reduction technique is simple, safe, and effective in reducing the collapsed central endplate in thoracolumbar burst fractures. Such a practical reduction strategy does not need additional medical costs.     

开放与经皮短节段椎弓根固定治疗胸腰椎骨折的效果

目的分析开放与经皮短节段椎弓根固定治疗胸腰椎骨折的临床效果。方法对94例单节段胸腰椎骨折患者采用短节段椎弓根固定治疗:18例开放复位跨伤椎固定(OPSF-4钉组),42例开放复位附加伤椎固定(OPSF-6钉组),21例经皮跨伤椎固定(PPSF-4钉组),13例经皮附加伤椎固定(PPSF-6钉组)。分析并比较4组的手术时间、术中出血量、术后引流量、术后当天疼痛VAS评分以及术后和末次随访时的伤椎前柱高度、后凸角、矢状位Cobb角。结果患者均获得随访,时间24~32个月。术中出血量4组差异有统计学意义(P<0.001),PPSF-4钉组、PPSF-6钉组均少于OPSF-4钉组、OPSF-6钉组(P<0.05)。术后引流量OPSF两组比较差异无统计学(P>0.05),PPSF两组术后无引流。手术时间和术后当天VAS评分4组比较差异无统计学意义(P>0.05)。术后和末次随访时,伤椎前柱高度比4组比较差异有统计学意义(P<0.05),OPSF-6钉组大于其余3组(P<0.05);其余3组组间比较差异无统计学意义(P>0.05);矢状位Cobb角、伤椎后凸角4组比较差异无统计学意义(P>0.05)。结论短节段椎弓根固定是治疗胸腰椎骨折的有效方法,OPSF-6钉能更好地矫正伤椎的高度,经皮固定的失血量明显减少。     

AF椎弓根固定技术治疗骨质疏松伴胸腰椎骨折脱位疗效分析

目的探讨AF椎弓根固定技术治疗骨质疏松伴胸腰椎骨折脱位效果。方法回顾分析29例患者术前术后临床及影像学资料和随访结果,测量矢状指数、椎体压缩高度、后凸畸形Cobb角,评估植骨融合的远期治疗效果。结果术后随访3-48个月,骨折复位满意,椎体高度矢状径指数从伤前的41%恢复到术后的92%,未发生螺钉断裂或脱出现象。22例二次术后18个月取出内固定后随访12-36个月,椎体高度矢状径指数为91%,X线片未见后凸加重或变形,未出现再次塌陷。结论骨质疏松伴胸腰椎骨折脱位应采用综合治疗,有效的椎弓根复位固定技术、撬拨复位恢复椎体高度及充足可靠的植骨融合技术是保持良好疗效的关键。     

多节段胸腰椎脊柱骨折的手术治疗

目的探讨椎弓根钉棒系统治疗多节段胸腰椎脊柱骨折的手术方式与疗效。方法采用后路切开复位、椎弓根钉棒系统内固定、选择性椎管减压及后外侧植骨融合手术治疗44例多节段胸腰椎骨折患者,对患者术前与随访时的ASIA分级、伤椎椎体高度矫正率进行分析。结果全部患者平均随访12个月,未发现内固定物松动、断裂,椎体高度由术前平均49.3%恢复至术后平均92.5%。ASIA分级较术前平均提高1.2级。结论后路切开复位、椎弓根钉棒系统内固定基础上选择性椎管减压＋植骨融合是治疗多节段胸腰椎脊柱骨折的理想选择。     

后路短节段钉棒系统结合经伤椎置钉固定治疗胸腰椎爆裂性骨折

目的探讨短节段经伤椎椎弓根螺钉固定治疗胸腰椎爆裂性骨折的临床疗效。方法对36例胸腰椎爆裂性骨折经伤椎行短节段椎弓根螺钉固定。术后定期X线复查患者的椎体高度、Cobb角、椎管矢状径占有率;对神经功能ASIA分级进行分析。结果患者均获得随访,时间6—24个月,植骨均获骨性愈合。末次随访时伤椎高度由术前的43．2％±1．8％恢复至91．0％±2．O％,Cobb角由术前24．2°±3．0°恢复至5．0°±1．0°,椎管矢状径由术前的60．2％±8．7％增加到85．5％±12．8％。术后神经功能ASIA分级：除2例A级无变化外,其余均有1～2级恢复。未出现螺钉松动及断裂。结论经伤椎椎弓根螺钉椎体固定治疗胸腰椎爆裂性骨折矫正度丢失小,疗效满意。