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。

Clinical application of the combination of postural reduction and kyphoplasty for traumatic thoracolumbar spine fractures

Objective: To determine the efficacy and feasibility of the combination of postural reduction and percutaneous kyphoplasty for traumatic thoracolumbar spine fractures. Methods: Thirty-seven patients with single level traumatic thoracolumbar spine fractures were included in this study. There are 28 males and 9 females,with an average age of 48 years (range 24 to 79 years). Patients were treated with postural reduction and then percutaneous vertebroplasty with Calcium Phosphate Cement(CPC)were performed on the fractured vertebra. The results were quantitatively evaluated, according to the concept of estimated vertebral height loss and kyphotic angle of the vertebral fractures by preoperative and postoperative plain standing lateral radiographs. Visual analog scale(VAS)and the fracture vertebra shape changes were recorded. Results: Patients were followed up for 9 to 24 months(average 13 months),pain was significantly relieved compared with the preoperative,VAS was reduced averagely from 7.6±2.5 to 1.8±1.5,the anterior and middle vertebral height was restored and kyphotic angle was corrected. During the period of follow up,outcomes were satisfactory,without notable correction loss. Conclusion: If the indications are correctly handled,the combination of postural reduction and percutaneous kyphoplasty for the treatment of traumatic thoracolumbar spine fractures can provide significant pain relieve and restore the vertebral height and kyphotic angle.