经伤椎椎弓根硫酸钙人工骨椎体成形术结合内固定治疗胸腰椎爆裂性骨折

目的 探讨经伤椎椎弓根硫酸钙人工骨椎体成形术结合内固定治疗胸腰椎骨折的临床效果. 方法 自2005年11月至2008年12月对32例胸腰椎爆裂性骨折患者采用经伤椎椎弓根硫酸钙人工骨成形术结合钉棒内固定治疗.观察术前、术后2 d及术后6个月随访的后凸Cobb角、伤椎前缘高度比值和椎管横截面积侵占率的改善情况. 结果所有患者未出现切口感染,无神经损伤及加重.所有患者获得6～24个月(平均14.2个月)随访.后凸Cobb角、伤椎前缘高度比值及椎管横截面积术后即刻与术前比较差异均有统计学意义(P<0.05),术后6个月随访时与术后即刻比较差异均尢统计学意义(P>0.05).本组患者无螺钉松动或断裂,植骨融合率100%.结论 经伤椎椎弓根硫酸钙人工骨成形术结合内固定治疗胸腰椎爆裂性骨折手术操作简单,提供了伤椎前中柱支撑和固定,能够有效地恢复并维持伤椎的高度.

Thoracolmnbar burst fractures treated with vertebroplasty reinforced by injectable calcium sulfate and pedicle screw fixation

Objective To explore the clinical results of injectable calcium sulfate vertebroplasty and pedicle screw fixation for the treatment of thoracolumbar burst fractures. Methods From November 2005 to December 2008, 32 patients with thoracolumbar burst fracture were treated with vertebroplasty reinforced by calcium sulfate injection and pedicle screw fixation. The ratio of anterior vertebral height, spinal canal cross section area and Cobb angle were determined on their X-ray and CT before operation, after operation and at the 6-month follow-up. Results No patients had iatrogenic spinal cord injury or other complications. All the cases had been followed up for 6 to 24 months (mean, 14. 2 months). The ratio of anterior vertebral height,Cobb angle and spinal canal cross section area between preoperation and postoperation were significantly dif-ferent (P<0.05), but not significantly different between postoperation and 6-month follow-up (P >0.05).There was no breakage of the pedicle screw or loosening of the implant. Conclusion Vertebroplasty re-inforced by injectable calcium sulfate and pedicle screw fixation is a safe and effective method for thora-columbar burst fractures, because it can restore the vertebral mechanical strength, maintain kyphosis correc-tion, and reduce instrument failure and loss of vertebral height.