短节段椎弓根内固定与椎体成形术联合治疗胸腰椎骨折

目的　探讨应用短节段椎弓根内固定加椎体成形术治疗胸腰椎骨折的方法和效果。方法　2 2例胸腰椎骨折患者应用后路短节段椎弓根内固定,X线透视下经伤椎椎弓根注射磷酸钙骨水泥行椎体成形术。结果　2 2例手术前伤椎椎体前、后缘高度、Cobb角及椎管狭窄率分别为4 9.4 %、83.1%、2 2 .8°、36 .2 % ,手术后分别为92 .5 %、95 .7%、3.6°、12 .4 % (P<0 .0 5 )。术后无新的神经症状出现;椎管内及椎间孔无明显渗漏。随访5～16个月,除2例神经功能A级脊髓神经症状无改善外,其余均有1～3级恢复;无内固定失败及伤椎高度明显丢失者。结论　短节段椎弓根内固定加椎体成形术治疗胸腰骨折是一种安全有效的治疗方法。

Treatment of thoracolumbar vertebral fractures with short-segment pedicle instrument and vertebroplasty

Objective To explore the method and effect of short-segment pedicle instrument on thoracolumbar blow-out fracture.Methods After reduction and fixation with short segment pedicle instrumentation were performed transpedicular vertebroplasty of the fractured vertebrae with injectable self-setting calcium phosphate cement was carried out under fluoroscopic guidance in 22 patients with thoracolumbar fractures.Results The average height of anterior and posterior column of injured vertebral bodies,angle of Cobb and the rat of spinal stenosis were 49.4%, 83.1%,22.8°and 36.2% respectively before operation. The average height of anterior and posterior column of injured vertebral bodies,angle of Cobb and the rat of spinal stenosis were 92.5%,95.7%,3.6°and 12.4% respectively after operation(P<0.05).All patients obtained successful surgery without neurological complications. There were little extrusion of cement in vertebral canal and intervertebral foramen. They were followed up for 5～16 months (average 9.5 months). Except 2 patients with the spinal cord function for grade A,other the patients had average improvement of degree 1to 3 on the spinal core function.All patients were perfectly recovered without noble correction loss or implant failure during following-up.Conclusion Reduction,fixation of short segment pedicle instrument and vertebroplasty with injectable self-setting calcium phosphate cement is a safe and effective method for thoraclumbar blow-out fracture.