短节段椎弓根内固定并伤椎重建术治疗胸腰椎骨折

目的 评价经后路矫形固定结合椎体撬拨植骨术治疗胸腰椎骨折的临床疗效.方法 采用经后路椎弓根螺钉矫形固定,同时经椎弓根对骨折椎体进行撬拨,恢复椎体前、中柱高度,并行椎体内植骨治疗30例(34椎)胸腰椎骨折.男23例,女7例;年龄24～77岁,平均40.8岁.所有患者均为外伤性骨折,其中6例合并骨质疏松.植骨材料分别采用Cem-Ostetic人工骨浆(3例)、自体骨(17例)和同种异体骨(10例).随访观察患者疼痛视觉模拟评分(visual analogue scale,VAS)及影像学改变情况.结果所有患者术后均获12～24个月随访,平均18个月.术前、术后1周及末次随访,椎体前高分别平均为(15.5±3.8)mm、(23.3±5.7)mm和(22.5±5.1)mm;椎体后高分别平均为(25.8±3.4)mm、(28.6±2.0)mm和(28.3±2.2)mm;后凸角度平均分别为23.5±7.6°、14.3°±7.1°和15.7°±7.5°;VAS分别平均为7.57±1.45、2.57±0.65和2.07±0.62.各项指标均较术前有显著改善,差异有统计学意义(P<0.05),而末次随访与术后1周比较差异无统计学意义(P>0.05).随访期间内固定无松动、断裂等.骨折椎体密度等同或高于上、下邻椎体,部分行后外侧植骨融合病例亦达到临床融合标准.结论 经后路矫形固定结合椎体撬拨植骨治疗胸腰椎骨折,可有效恢复和维持椎体高度,提高骨折椎体密度,增强脊柱前、中柱的稳定性.

Short-segment pedicle fixation and reconstruction for treatment of thoracolumbar fractures

Objective To evaluate the clinical effects of posterior instrumentation fixation combined with the vertebral lifted bone grafting to treat thoracolumbar fractures. Methods Thirty patients (34 verte-brae) with thoracolumbar fractures were treated with posterior instrumentation fixation, restoring the anterior and middle column height of vertebral body and inserting the bone graft through the pedicle. There were 23 males and 7 females with an average age of 40.8 years (range, 24-77 years). All patients were traumatic frac-tures (6 patients with osteoporosis). The bone grafting included Cem-Ostetic 3 cases, autograft 17 cases and allograft 10 cases. The visual analogue scale (VAS) and imagiological changes were followed up. Results All patients were followed up for 12-24 months (average, 18 months). At the preoperation, one week postop-eratively and final follow-up, the average anterior height of the vertebral body were (15.5±3.8) mm, (23.5±7.6) mm and (22.5±5.1) mm; and the average posterior height of vertebral body were (25.8±3.4) mm, (28.6±2.0) mm and (28.3±2.2) mm; the average Cobb angle were 23.30°±5.7°, 14.3°±7.1° and 15.7°±7.5°. The av-erage VAS score were 7.57±1.45, 2.57±0.65 and 2.07±0.62. All indices above were significantly improved,there was a significant difference between at the preoperation and on week postoperatively (P< 0.05), but no significant difference between final follow-up and one week postoperatively (P>0.05). All patients were cured and instrumentations were not loose and broken. The bone mineral density of all fractured vertebral bodies was equal or higher than the adjacent levels. Conclusion For restoring and maintaining the height of the vertebral body and improving the density of the vertebral body, the posterior instrumentation combined with the vertebral lifted bone grafting is an ideal method to treat thoracolumbar fractures, especially for stability of the anterior and middle column of the vertebral body.