计算机导航辅助下行后路内固定椎体植骨治疗胸腰椎骨折

目的 探讨计算机导航辅助下行后路椎弓根螺钉复位固定结合伤椎椎体人工骨植骨术治疗胸腰椎骨折的方法与疗效。方法 2005年6月至2009年3月应用计算机导航辅助下行胸腰椎后路椎弓根螺钉复位固定结合伤椎椎体人工骨植骨术治疗胸腰椎骨折患者30例，男18例，女12例；年龄21～57岁，平均35.5岁；骨折部位：T11 3例，T12 11例，L1 14例，L2 2例。神经功能按Frankel分级：A级2例，B级3例，C级3例，D级7例，E级15例。结果 所有患者术后获12～ 36个月（平均18个月）随访。120枚椎弓根螺钉中，0级螺钉110枚，Ⅰ级螺钉8枚，Ⅱ级螺钉2枚。螺钉优良率为98.3％，无出现Ⅲ级螺钉。术后及末次随访时椎管内占位、椎体高度比值及Cobb角较术前均明显改善，差异有统计学意义(P＜0.05)。长期随访术后Cobb角丢失＜1 °，椎体前缘高度丢失＜2 mm，无断钉及内固定松动现象。结论 计算机导航辅助下行后路椎弓根螺钉复位固定结合伤椎椎体人工骨植骨可以增加手术的准确性和安全性，是一种理想的内置物引导模式。

Navigation-guided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures

ObjectiveTo assess the outcomes of navigation-guided posterior fixation plus transpedicular vertebroplasty for thoracolumbar fractures.MethodsFrom June, 2005 through March,2009, 30 patients with thoracolumbar fracture underwent navigation-guided posterior fixation with transpedicular vertebroplasty in our department. They were 18 men and 12 women, aged from 21 to 57 years (mean,35.5 years). Three fractures occurred on T11, 11 on T12, 14 on L1, and 2 on L2.Results The follow-ups averaged 18 months ( 12 to 36 months). Of the 120 pedicle screws inserted, 110 were of degree 0, 8of degree I, 2 of degree Ⅱ, 0 of degree Ⅲ. The total good to excellent rate was 98.3％ for the screw insertion. Before operation, the average canal compromise was 37.5％ (5％ to 70％ ), the average vertebrae compression was 54. 5％ (40％ to 70％ ), and the average Cobb angle was 29. 5° ( 15.5° to 41.5°). Postoperatively the average canal compromise was 14. 3％ (0 to 20％ ), the average height of vertebrae was 91.3％ (80％ to 100％ ) and the average Cobb angle was 4. 9° ( 1. 3° to 9. 1°). The long-term follow-ups showed an average Cobb angle loss of ＜ 1° and an average vertebral height loss of ＜ 2 mm.Conclusions The navigation-guided posterior fixation plus transpedicular vertebroplasty is an effective treatment for thoracolumbar fractures. Computer-assisted navigation system enhances accuracy and further improves the safety of spine surgery, compared with just the anterior or posterior fixation.