经皮穿刺后路脊柱内固定术治疗胸腰椎骨折

目的 探讨经皮穿刺胸腰椎椎弓根螺钉系统内固定的可行性及临床意义。方法 2002年9月至2003年12月采用经皮穿刺胸腰椎椎弓根螺钉系统内固定，椎管减压，经椎弓根椎体内植骨，治疗胸腰椎骨折16例。结果 手术时间：130—210min，平均162min。术中出血量：20—320ml，平均160ml。手术后节段后凸Cobb角纠正率平均达85．2％。椎体塌陷纠正事平均为80．2％。均在术后3周佩戴腰围支具下床。术后3周复查ASIA分级，C缓恢复至D级3例，D级恢复至E级9例，保持D级2例，保持E级2例。结论 经皮穿刺胸腰椎椎弓根螺钉系统内固定创伤小，可以完成开放手术的所有步骤．但技术难度高、X线暴露时间长。

Posterior percutaneous transpedicular spine instrumentation in the treatment of thoracolumbar and lumbar fractures

Objective To study the feasibility and significance of posterior percutaneous transpedicular spine instrumentation method in treating the thoracolumbar and lumbar fractures. Methods 16 patients with thoracolumbar or lumbar fracture were operated with the posterior percutaneous transpedicular spine instrumentation method from Sep.2002 to Dec.2003. All of them were underwent posterior decompression in spinal canal. The autogenous cancellous bone was grafted through pedicle of vertebral arch to vertebral body at the same time. Results The operations took from 130 to 210 minutes, with the average of 162 minutes. The bleeding volume in the operation was from 20 to 320 ml, with the average of 160 ml. After the operation, about 85.2% of segmental posterior convex and 80.2% of collapse of vertebra were corrected. All the patients were out of bed 3 weeks later with the assistance of girdle brace. Effects of treatment were evaluated as ASIA grade: 3 cases were recovered from C to D, 9 cases from D to E, 2 cases kept in D and another 2 cases kept in E. Conclusion Posterior percutaneous transpedicular spine instrumentation was showed as a safe and accurate method with less invasive modality. With this method, immediate solid fixation could be achieved in the treatment of thoracolumbar and lumbar fractures, and all the instrumentation of vertebroplasty could be finished, though it has some technical difficulties and the disadvantage of long-time exposure under X ray.