后路减压椎弓根钉固定骨水泥注射椎体成形术治疗胸腰椎骨折

目的探讨采用后路减压,椎弓根钉内固定结合分步骨水泥注射,椎体成形术治疗胸腰椎骨折的临床疗效。方法 2007年1月至2010年4月,我科采用后路减压,椎弓根钉系统内固定结合分步骨水泥注射,椎体成形术治疗胸腰椎骨折28例,其中M cA fee分类,Ⅰ型15例,Ⅱ型10例,Ⅲ型3例,并观察患者术前及术后2周、术后12个月以伤椎为中心的脊柱功能单位的前后缘压缩比,椎管侵占率和Cobb角。结果本组患者全部得到随访,时间12～16个月。患者均于术后2周后下床活动,无断钉、断棒、椎体再压缩等并发症,椎体高度恢复满意,无神经症状加重,术前脊柱功能单位前后缘压缩比、椎管侵占率和Cobb角与术后2周相比有明显差异,而术后2周与术后12个月无明显差异。结论后路减压,椎弓根钉系统内固定结合分步骨水泥注射椎体成形术治疗胸腰椎骨折,能在早期恢复脊柱前后柱的稳定性,避免了单纯后路椎弓根系统内固定断钉、断棒的危险,从而能使患者早期无痛下床活动,临床效果满意。

Thoracolumbar Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation and Staged-Injection Vertebroplasty

Objective To evaluate the clinical results of posterior decompression,pedicle screws instrumentation and staged-injection vertebroplasty in treatment of thoracolumbar fractures.Methods 28 cases were treated by posterior decompression,pedicle screws instrumentation and staged-injection vertebroplasty,including McAfee classification：1 type 15 cases,2 type 10 cases,and 3 type 3 cases,and observed the compression ratio of anterior and posterior edge of the function unit of spine with the center of injury vertebrae body,the invasion rate of vertebral canal and Cobb′s angle.Results All cases were followed for 12～16months and began to ambulate 2 weeks postoperatively.No postoperative complications were found such as nails breaking,shaft breaking and second vertebral body compression.The body height and physiological curve recovered satisfactorily.The obvious difference exists in comparision with preoperative and 2 weeks postoperative observations including the compression ratio of anterior and posterior edge of the function unit of spine with the center of injury vertebrae body,the invasion rate of vertebral canal and Cobb′s angle.There was no obvious difference with postoperative 2 weeks and 12 months.Conclusion Treatment of thoracolumbar fractures with posterior decompression,pedicle screws instrumentation and staged-injection vertebroplasty can earlier recover the spine stability of anterior and posterior column,avoid the risk of nails breaking and shaft breaking of purely posterior pedicle screws instrumentation.Patients can early ambulate with no back pain and gain satisfactory clinical results.