肌间隙入路椎弓根钉固定结合椎体成形术治疗胸腰椎骨折

目的:观察经肌间隙入路椎弓根钉固定结合椎体成形术治疗胸腰椎骨折的临床疗效。方法:对31例新鲜单节段胸腰椎骨折,采用体外过伸手法复位,结合经肌间隙入路椎弓根钉复位、固定,通过伤椎椎弓根注射自固化人工骨水泥,根据术前、术后侧位X线片,测量椎体高度、后凸角,并计算椎体高度的压缩率及后凸角恢复率。结果:31例手术均获成功,术后48h腰背创口VAS疼痛评分明显降低。术后3~8个月自固化人工骨水泥降解骨化,平均13个月拆除内固定,椎体前中柱高度明显恢复,后凸角得到矫正。结论:经肌间隙入路椎弓根钉固定结合椎体成形术是一种治疗胸腰椎骨折的可行性方法,手术创伤小,能恢复伤椎前中柱的力学强度,减少椎弓根钉的失败率。     

经Wiltse入路椎弓根钉复位固定结合伤椎植骨治疗胸腰椎骨折的近期疗效评价

目的探讨经Wiltse入路椎弓根钉复位固定结合伤椎植骨术治疗胸腰椎骨折的临床疗效。方法回顾性分析诊治的胸腰段脊柱单发椎体骨折33例,其中经传统入路椎弓根钉复位内固定组14例,经Wiltse入路椎弓根钉复位固定结合伤椎植骨组19例。结果经Wiltse入路组术中出血量、术后引流量及术后48 h VAS评分均明显低于经传统入路组;经Wiltse入路组手术时间较经传统入路组手术时间延长;术后Cobb角恢复情况2组无明显差异,但术后6个月复查发现常规入路手术组伤椎椎体高度有不同程度下降。结论经Wiltse入路椎弓根钉复位固定结合伤椎植骨术能很好地恢复并维持椎体高度,减少术中出血并减轻术后疼痛。     

两种手术方法治疗胸腰椎骨折的疗效比较

正胸腰椎骨折多采取后路复位内固定。传统后路手术方法为后正中入路跨伤椎4钉双平面复位固定,广泛剥离椎旁肌,损伤大,复位困难、不理想。为解决以上问题,近年来,肌间隙入路、伤椎置钉技术、经椎弓根椎体内植骨技术逐渐应用于胸腰椎骨折。本文选择2013-03-2015-06笔者收治41例无神经症状的胸腰椎骨折患者,随机分成两组,分别采取肌间隙入路伤椎植骨内固定和传统后路双平面椎弓根钉固定     

经椎旁肌间隙入路钉棒固定并伤椎植骨治疗胸腰椎骨折

目的探讨经椎旁肌间隙入路钉棒固定并伤椎植骨治疗无神经损伤胸腰椎爆裂骨折的疗效。方法对95例无神经损伤胸腰椎骨折患者均采用经椎旁肌间隙入路螺钉固定,伤椎经椎弓根异体骨植骨手术方法。术前、术后和随访期间均摄X线片,检测椎体高度丢失情况以及Cobb角度变化,观察骨折愈合和术后并发症情况。结果手术时间100～150min,术中出血量100～250ml。95例均获随访,时间12～24个月,骨折均获得愈合。术后椎体高度恢复满意,矢状面畸形矫正,无明显的后凸角和高度丢失。6例螺帽松动。结论经椎旁肌间隙入路椎弓根螺钉内固定植骨治疗DenisB型骨折手术时间短,并发症少,疗效良好。     

肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗胸腰椎骨折

目的 探讨肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗胸腰椎骨折的疗效。方法 采用肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗28例胸腰椎骨折患者。记录手术时间、术中出血量、并发症发生情况、疼痛VAS评分、后凸Cobb角、伤椎前缘及中柱高度百分比。采用改良MacNab标准评价临床疗效。结果 患者均获得随访，时间12～36(19.2±4.2)个月。手术时间105～180(143.8±24.3) min,术中出血量80～150(103.1±20.3) ml。术后无脊髓神经功能损害及椎弓根螺钉松动、移位、断裂等并发症发生，无“蛋壳椎”形成。疼痛VAS评分、后凸Cobb角、伤椎前缘及中柱高度百分比：术后3 d、12个月均明显优于术前(P<0.05),术后12个月与术后3 d比较差异均无统计学意义(P>0.05)。末次随访时采用改良MacNab标准评价临床疗效：优24例，良3例，可1例，优良率为27/28。结论 采用肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗胸腰椎骨折，具有创伤小、出血量少、患者可早期康复锻炼及改善腰背部疼痛等优点，且能有效恢复并维持椎体高度...     

椎旁肌间隙入路结合伤椎椎弓根钉固定治疗胸腰段椎体骨折

目的评估椎旁肌间隙入路结合伤椎椎弓根钉固定治疗胸腰段椎体骨折的临床疗效。方法将40例胸腰段椎体骨折患者分为经椎旁肌间隙入路结合伤椎椎弓根螺钉内固定组(A组,20例)和传统后正中入路跨伤椎椎弓根螺钉内固定组(B组,20例),比较两组的手术时间、术中及术后出血量、VAS评分、椎体高度矫正率、复位丢失率等项指标。结果手术时间、术后即刻椎体高度矫正率两组比较差异无统计学意义(P0.05);两组术后VAS评分与术前比较差异均有统计学意义(P0.05);出血量、术后VAS评分、术后3个月椎体高度矫正率、复位丢失率A组均优于B组,差异有统计学意义(P0.05)。结论椎旁肌间隙入路结合伤椎椎弓根钉固定治疗胸腰段椎体骨折具有术者操作简单、创伤小、出血少、疗效好等优点。     

短节段或单节段内固定结合经椎弓根伤椎植骨对胸腰椎骨折愈合的疗效分析

目的 探讨采用短节段或单节段内固定结合经椎弓根伤椎植骨对胸腰椎骨折愈合的疗效.方法 对34例胸腰椎骨折,应用经伤椎椎弓根椎体内植骨,结合短节段或单节段椎弓根钉棒系统复位固定.结果 术后随访12～26个月,后凸Cobb角由术前的平均20.7°恢复至术后平均3.7°.椎体前缘高度由术前的平均55.3％,恢复至术后平均86.6％.伤椎复位效果好,无明显相邻椎间隙过度撑开.结论 经伤椎椎弓根椎体内植骨,结合椎弓根钉棒系统复位固定治疗胸腰椎骨折,重建了脊柱前中柱的力学结构,获得了稳定性,同时获得有效的椎间盘高度,容纳复位后的髓核,减少伤椎上终板的塌陷,可明显减少内固定断裂、术后Cobb角丢失等并发症.     

椎体成形术在新鲜胸腰段骨折中的选择性应用

目的：探讨复位的损伤椎体内灌注ACPC进行椎体成形术在胸腰椎骨折的临床应用价值。方法：9例胸腰段骨折行椎弓根螺钉固定，后路减压复位占位骨块，经伤椎椎弓根椎体复位，椎体内灌注自固化磷酸钙骨水泥。结果：术后神经恢复1～2级，椎体高度及生理弧度维持良好。结论：本术式安全，有效实用，值得临床应用。     

椎旁肌间隙入路并伤椎单侧置钉治疗不稳定型胸腰椎骨折

正对于不稳定型胸腰椎骨折,手术常采用后路切开复位、椎弓根螺钉内固定术。传统的手术入路需广泛剥离椎旁肌,有出血多、术后腰背痛发生率高的缺点,近年来主要的改进在于经皮微创椎弓根技术及椎旁肌间隙入路置钉技术。另外,传统的螺钉固定方式常选择伤椎相邻椎体置钉,术后即刻稳定性差,有内固定失效及伤椎高度丢失的风     

椎旁肌间隙入路联合经椎弓根伤椎椎体内植骨治疗无神经损伤的胸腰椎骨折的疗效分析

目的探讨采用椎旁肌间隙入路联合经椎弓根伤椎椎体内植骨治疗无神经损伤的胸腰椎骨折的临床意义及有效性。方法采用椎旁肌间隙入路联合经椎弓根伤椎椎体内植骨治疗无神经损伤的胸腰椎骨折24例。结果术后获随访平均18个月,后凸Cobb角由术前的平均20．7μ恢复至术后平均6．2μ。椎体前缘高度与正常高度的百分比由术前的平均55．3％恢复至术后平均85．4％。结论采用本术式治疗无神经损伤的胸腰椎骨折可有效复位骨折及维持矫正效果,具有肌肉组织损伤轻、出血少和明显降低手术创伤导致椎旁肌退变及术后腰背痛的发生率等优点。     

后凸成形术结合体位复位治疗创伤性胸腰椎椎体骨折的临床观察

目的：观察在体位复位辅助下后凸成形术治疗创伤性胸腰椎椎体骨折的临床疗效。方法：37例新鲜单节段胸腰椎椎体骨折患者,男28例,女9例;年龄24～79岁,平均48岁。通过体位复位及Sky扩张器撑开复位后,经双侧椎弓根穿刺充填自固化磷酸钙人工骨（CPC）。根据Denis胸腰椎骨折的分型：压缩性骨折,B型27例,C型3例,D型5例;爆裂性骨折2例,均为B型。利用体位复位,经皮穿刺,Sky椎体成形器扩张椎体,注入可降解的自固化磷酸钙人工骨。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度丢失率和后凸畸形矫正率,记录分析视觉模拟评分（VAS）及伤椎形态变化。结果：术后随访9～24个月,平均13个月。术后伤椎处疼痛均显著缓解,VAS评分改变从术前平均（7.6±2.5）分降至术后平均（1.8±1.5）分,椎体前壁高度和中间高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。结论：在严格掌握适应证、选择合适病例的前提下,采用体位复位辅助下经皮椎体后凸成形术治疗创伤性胸腰椎椎体骨折,能迅速缓解疼痛,有效恢复椎体高度和矫正后凸畸形。     

Retrospective, propensity score-matched cohort study examining timing of fracture fixation for traumatic thoracolumbar fractures

Abstract The timing of surgery in patients with traumatic thoracic/thoracolumbar fractures, with or without spinal cord injury, remains controversial. The objective of this study was to determine the importance of the timing of surgery for complications and resource utilization following fixation of traumatic thoracic/thoracolumbar fractures. In this retrospective cohort study, the 2003-2008 California Inpatient Databases were searched for patients receiving traumatic thoracic/thoracolumbar fracture fixation. Patients were classified as having early (<72?h) or late (>72?h) surgery. Propensity score modeling produced a matched cohort balanced on age, comorbidity, trauma severity, and other factors. Complications, mortality, length of stay, and hospital charges were assessed. Multivariate logistic regression was used to determine the impact of delayed surgery on in-hospital complications after balancing and controlling for other important factors. Early surgery (<72?h) for traumatic thoracic/thoracolumbar fractures was associated with a significantly lower overall complication rate (including cardiac, thromboembolic, and respiratory complications), and decreased hospital stay. In-hospital charges were significantly lower ($38,120 difference) in the early surgery group. Multivariate analysis identified time to surgery as the strongest predictor of in-hospital complications, although age, medical comorbidities, and injury severity score were also independently associated with increased complications. We reinforce the beneficial impact of early spinal surgery (prior to 72?h) in traumatic thoracic/thoracolumbar fractures to reduce in-hospital complications, hospital stay, and resource utilization. These results provide further support to the emerging literature and professional consensus regarding the importance of early thoracic/thoracolumbar spine stabilization of traumatic fractures to improve patient outcomes and limit hospitalization costs.     

保守治疗与后路手术治疗胸腰椎A型骨折的疗效观察

目的观察无神经损伤同时伴椎管侵占的胸腰椎A型骨折保守治疗与后路手术治疗的中长期疗效并验证胸腰椎骨折严重性评分TLICS（Thoracolumbar Injury Classification and SeverityScore）分型系统评分对治疗方式选择的指导意义。方法 2002-01-2007-10我院收治74例无神经损伤胸腰椎A型骨折,分别接受保守治疗和后路手术治疗,随访并应用TLICS评分系统对病例进行评分。收集观察患者入院时、术后即时、及末次随访时X线片及CT片,测量侧位X线片上椎体复位情况,对腰背痛等指标于入院时、术后1个月、术后3个月及末次随访时采用目测类比评分（visualanalogue scale,VAS）,比较两组病例末次随访时工作能力恢复情况,并对数据进行统计学分析。结果两组随访时间及VAS评分及恢复工作比例,组间差异无显著性（P〉0.05）;其余指标（如：平均卧床时间、平均恢复工作时间、平均住院费用、椎体前高、椎体后高、Cobb角、椎管侵占率）差异有显著性意义（P〈0.05）。结论 （1）无神经损伤胸腰椎A型爆裂骨折手术治疗在早期改善症状、缓解疼痛及矫正畸形等方面明显好于保守治疗。（2）无神经损伤胸腰椎A型爆裂骨折手术治疗和保守治疗的中长期功能结果相似。（3）无神经损害的TLICS分型系统评分为4分的胸腰椎A型爆裂骨折,保守治疗和手术治疗均可作为治疗的选择。     

硫酸钙椎体成形术联合椎弓根钉内固定治疗创伤性胸腰椎骨折的前瞻性研究

目的探讨注射型硫酸钙椎体成形术联合椎弓根钉内固定治疗创伤性胸腰椎骨折的初步临床疗效。方法自2008年3月~2010年5月,采用注射型硫酸钙椎体成形术联合后路短节段椎弓根钉内固定治疗25例无神经障碍的创伤性胸腰椎骨折,术后随访观察椎体前、中部的相对高度、Cobb角、伤椎角,并对疼痛和功能指标分别用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)进行量化比较。结果 23例得到随访13~35个月,平均23.8个月。术后1周时椎体前、中部的相对高度、Cobb角,伤椎角分别与术前值比较,差异有统计学意义(P<0.05),而与末次随访时比较,差异无统计学意义(P>0.05)。结论硫酸钙椎体成形术联合椎弓根钉内固定治疗创伤性胸腰椎骨折可以有效防止内固定失败和矫正度丢失,临床效果满意。     

椎体成形术结合体位复位治疗创伤性胸腰椎骨折

目的 观察在体位复位辅助下椎体成形术治疗创伤性胸腰椎椎体骨折的临床疗效.方法 2003年1月至2006年2月,48例新鲜单节段胸腰椎椎体骨折患者,男36例,女12例;年龄24-76岁,平均50岁.其中T114例,T1212例,L118例,L2 8例,L3 4例,L42例.根据Denis胸腰椎骨折分型:压缩性骨折,B型32例,C型6例,D型8例;爆裂性骨折2例,均为B型.取俯卧位调节手术床使患者椎体骨折部位过伸,达到满意的闭合复位后,经皮双侧椎弓根穿刺充填自固化磷酸钙骨水泥.根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度压缩率及恢复率.记录分析视觉模拟评分(VAS)及伤椎形态变化.结果 术后随访15～37个月,平均18个月.术后伤椎处疼痛均显著缓解,VAS评分从术前平均(6.9±1.6)分降至术后平均(1.7±0.8)分,椎体前壁高度和中间高度明显恢复,后凸畸形得到矫正.随访期间疗效满意,伤椎高度无明显丢失.结论 在严格掌握手术适应证,选择合适病例的前提下,采用体位复位辅助下经皮椎体成形术治疗创伤性胸腰椎椎体骨折,能迅速缓解疼痛,有效恢复椎体高度和矫正后凸畸形.     

Balloon kyphoplasty in traumatic fractures of the thoracolumbar junction. Preliminary experience in 12 cases

AIM: The purpose of this study was to assess the effectiveness and safety of Ballon Kyphoplasty as a new method of treatment for traumatic fracture of the thoracolumbar junction. METHODS: We treated twelve patients 8 patients male and 4 female. The average age was 47,3 years (22-75 years). The interested vertebrae and therefore the procedures have been 13 since in a patient two vertebrae have been treated. In 9 cases the interested vertebra was L1, in 2 cases L2 and one case D11 and D12. Following the classification of Magerl 9 fractures were of A1.2 fractures and one fracture respectively of type A1.3, A2.2, A2.3, A3.1. We have never placed indication to Balloon Kyphoplasty in the fractures of the type B and C, neither in the complete burst fractures (A3.2 and A3.3), neither in the fractures of the A1.1 type. Balloon Kyphoplasty has been carried out using the Kyphon system (Kyphon Inc. Sunnyvale, CA, USA). In the patients older than 50 years (7 cases) we have used polymethylmethacrylate (PMMA), as filling material, while in the patients younger than 50 years (5 in total), we have used Calcibon (Biomet, Inc.Warsaw, Indiana) in 4 cases and in one case a new material called KyphOs (Kyphon Inc. Sunnyvale, CA, USA). These last two types of material are made up of tricalcium phosphate that, although less manageable of the PMMA and less resistant initially, in the time it will be reabsorbed and osteointegrated. RESULTS: The method demonstrated swift pain relief associated with an evident augmentation in the resistance and restoration of the vertebral body's physiological shape. No patient has worn a postoperative orthesis. In all the cases we obtained an optimal stabilization in the follow-up minimal to 4 months. In no case we observed a structural yielding of the vertebra. CONCLUSIONS: Kyphoplasty is an effective, alternative, simple and safe treatment of traumatic fracture of the thoracolumbar junction.     

No evidence for the effectiveness of bracing in patients with thoracolumbar fractures: A systematic review

Background and purpose The use of braces is widespread in patients with thoracolumbar fractures. The effectiveness of bracing, however, is controversial. We sought evidence for the effect of bracing in patients with traumatic thoracolumbar fractures based on outcome and length of hospital stay (LOS). Furthermore, we evaluated the incidence of complications of bracing.Methods An electronic search strategy with extensive MeSH headings was used in various databases to identify studies that compared bracing and non-bracing therapies. Two reviewers independently selected systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, and observational studies, and both assessed the methodological quality and extracted the data.Results No systematic reviews or RCTs were found. 7 retrospective studies were included. None of these studies showed an effect of bracing. Because of poor methodological quality, no best-evidence synthesis could be performed. One observational study was selected in which a complication of bracing was reported.Interpretation In the present literature, there is no evidence for the effectiveness of bracing in patients with traumatic thoracolumbar fractures. The lack of high-quality studies prevents relevant conclusions from being drawn.     

Clinical manifestations and significance of post-traumatic thoracolumbar syringomyelia

Objective: To analyze the pathogenic mechanism and the clinical significance of post-traumatic thoracolumbar syringomyella through reviewing the clinical manifestations. Methods: The data of 15 patients (14 males and 1 female, aged from 28 to 56 years, with an average of 36 years) with post-traumatic syringomyelia treated in our hospital from December 1997 to February 2002 were studied retrospectively. Two patients suffered from T11 fractures, 7 from T12 fractures and 6 from L1 fractures. There were 12 patients with burst fractures and 3 with fracture dislocations. Anterior decompression, bone graft, bone fusion and internal fixation were made on 6 patients,posterior decompression, bone graft, bone fusion and internal fixation on 1 patient, and non-surgical treatment on 8 patients. Results. Syringomyelia of the patients was diagnosed accurately with magnetic resonance imaging at 0.5-4 years after the original thoracolumbar fracture. The cavern was round in 6 cases, elliptic in 6 cases, and irregular in 3 cases. The patients also suffered from pain (80%), myodynamia attenuation in lower extremities (66.7%), aggravated spasm (46.7%), sensation loss or hypesthesia (46.7%), decreased coordinate function of lower extremities (20%) and autonomic nerve symptom (6.7%). Conclusions： Post-traumatic thoracolumbar syringomyelia should be suspected if the patient has new neurological symptoms, such as myodynamia attenuation in lower extremities, after the neural function becomes stable for certain time.     

脊髓前方减压与高压氧治疗胸腰椎骨折合并脊髓损伤

作者采用脊髓前方塌陷减压加高压氧治疗胸腰椎骨折合并脊髓损伤42例,单纯减压术22例。结果按Frankel分级,脊髓前方塌陷减压组恢复到D级以上者9例（平均改善2.1级）;脊髓前方塌陷减压加高压氧组恢复到D级以上者29例（平均改善2.8级）。作者认为脊髓前方塌陷减压加高压氧治疗脊髓损伤优于单纯塌陷减压术,高压氧具有促进神经功能恢复的作用。