后路经伤椎短节段椎弓根螺钉内固定术治疗A3型胸腰椎骨折的临床疗效

胸腰椎骨折是临床常见损伤,占全部脊柱骨折的90％ [1] ,部分A3型骨折患者的脊柱稳定性受破坏或产生神经损伤,需面临手术治疗[2].本研究比较经伤椎短节段椎弓根螺钉内固定术和单节段椎弓根螺钉内固定术治疗A3型胸腰椎骨折的手术情况及临床疗效,为临床治疗提供参考.     

胸腰椎骨折内固定术中经伤椎椎纠根椎体内植骨36例评价

目的 总结３６例胸腰椎骨折内固定术中经伤椎椎纠根椎体内植骨手术经验。方法 手术中采取透视下经伤椎椎纠根钴孔直接撬拨复位并经此孔行椎体内植骨,以提高复位效果及骨愈合质量,结果 ３６例病人得到随访。Ｘ线及ＣＴ复查示骨折椎体复原率达到９５％以上,椎管内有效矢经、横经达到正常;平均骨折愈合时间１０～１２周,结论 该方法在于具有伤椎整复更充实与饮满;植骨后更符合骨愈合生理要求;神经通道减压列彻底,功能恢复更显著等优点。     

可控撑开技术在胸腰椎骨折伤椎置钉短节段椎弓根钉内固定术中的应用效果观察

目的 评估可控撑开技术在胸腰椎骨折伤椎置钉短节段椎弓根钉内固定术中应用的可行性与有效性。方法 回顾性分析自2020-06—2022-03采用后路伤椎置钉短节段椎弓根钉内固定治疗的126例胸腰椎骨折,排除合并骨质疏松、需直接减压、椎间盘终板复合体严重损伤及AO-C型骨折患者,术中采用可控撑开技术复位骨折椎体。比较手术前后腰痛VAS评分、胸腰段Cobb角、椎管侵占率。结果 126例术后均获得随访,随访时间12～18个月,平均15.5个月。术后无关节突关节脱位、椎弓根钉松动断裂、骨折不愈合、感染等并发症发生。术前、术后第3天、术后1年腰痛VAS评分分别为（6.1±3.5）、（3.1±2.0）、（1.5±0.9）分,术后第3天腰痛VAS评分较术前降低,术后1年腰痛VAS评分较术后第3天降低（P<0.05）。术前、术后即刻、术后1年胸腰段Cobb角分别为（28.5±9.4）°、（5.3±2.6）°、（6.1±2.8）°,术后即刻胸腰段Cobb角较术前明显减小（P<0.05）,而术后1年与术后即刻的胸腰段Cobb角差异无统计学意义（P>0.05）。术后第3天骨折块椎管侵占率为（4...     

椎体中央与椎体侧方前路固定的实验比较

目的 本研究旨在实验条件下比较胸腰段椎体中央固定和椎体侧方固定的力学稳定,为前路器械的改进进行实验探索。方法 运用新鲜小牛脊柱标本,制造单个椎体缺损模型,并以该脊椎左、右两侧残留的上关节突应变变化为观察指标,将自行设计的钛合金椎体中央固定器、椎体侧方固定器（Ｋａｎｅｄａ、椎体钉、椎体钢板）分别固定,进行前屈加载、左侧弯加载、右侧弯加载比较。结果 椎体中央固定器最稳定、Ｋａｎｅｄａ在对侧侧弯加载有不     

胸腰椎骨折经椎弓根椎体内植骨术后伤椎愈合情况的对比

目的研究胸腰椎骨折经椎弓根植骨术后伤椎愈合的方式及影响因素。方法本次研究纳入自2011-01-2013-01诊治的74例具有完整随访结果的患者,采用经椎弓根植骨36例,同期未经椎弓根植骨38例。依据脊柱骨折负荷分享分级、笔者设计的椎体轴位9分区法明确骨折损伤程度、骨折复位及伤椎植骨情况、骨折愈合及伤椎植骨愈合情况。结果术后随访16~24个月,平均20个月。未植骨组:术后1年随访时椎体内各区形成空洞总计21.1%。植骨组:术后1年随访时椎体内各区形成空洞总计24.1%。结论胸腰椎骨折后伤椎经椎弓根植骨术中可撬拨复位塌陷及碎裂的上终板,减少髓核组织的突入发生,形成椎体内有效的可填充空腔,便于椎体内充分植骨,形成利于骨细胞爬行替代的框架结构,减少晚期上终板的塌陷及椎体内空洞的形成。     

经伤椎椎弓根置钉椎体内植骨治疗胸腰椎骨折

目的探讨经伤椎椎弓根一侧置钉一侧植骨治疗胸腰椎骨折的临床疗效。方法采用经伤椎椎弓根一侧置钉一侧植骨方法治疗胸腰椎骨折34例,测量伤椎楔变角、伤椎前后缘高度比等变化。结果术后伤椎楔变角、伤椎前后缘高度比等均明显改善,内固定未见松动,植骨融合,神经功能较术前有1～2级恢复。结论应用经伤椎一侧置钉一侧植骨,是治疗胸腰椎爆裂性骨折的有效方法。     

后路经伤椎内固定结合椎体内植骨治疗不稳定胸腰椎骨折的临床研究

目的观察后路经伤椎内固定结合椎体内植骨手术方式治疗不稳定性胸腰椎骨折的中远期临床疗效。方法 2008-02-2012-02,27例不稳定性胸腰椎骨折患者采用了经伤椎固定结合椎体内植骨手术方式进行治疗(A组),随机取同期仅行伤椎及相邻上下椎固定治疗的27例不稳定胸腰椎骨折患者(B组),进行对照观察。观察术前、术后及拆除内固定后伤椎前缘压缩率和后凸角(Cobb’s角)及神经功能恢复情况。结果 A组与B组比较,内固定拆除后椎体高度恢复率及后凸角组间差异皆有统计学差异(P0.05);A组内固定拆除后与术后当时相比无统计学差异(P0.05);B组内固定拆除后与术后当时相比有统计学差异(P0.05)。伤椎固定椎体内植骨组27例患者及对照组27例患者术后神经功能损伤均有一级以上神经功能恢复,神经功能损伤恢复组间比较差异无显著性(P0.05)。结论后路经伤椎内固定结合椎体内植骨术治疗不稳定性胸腰椎骨折能获得较好的中远期椎体复位效果。     

胸腰椎骨折三种不同内固定方式的疗效比较

目的:对比后路复位内固定治疗胸腰椎骨折中,传统短节段内固定、短节段内固定结合伤椎椎体成形术及经伤椎置钉三种不同内固定方式的临床疗效。方法:回顾性分析我院2010年1月~2014年10月收治的87例胸腰椎单节段骨折患者,其中30例行传统短节段内固定(A组),25例行短节段内固定结合伤椎椎体成形术(B组),32例行经伤椎置钉内固定(C组)。记录患者手术时间、术中出血量,测量手术前后及末次随访时的伤椎前缘高度比值(AVH)、区域后凸角(LKA)等影像学指标,在末次随访时观测CT矢状位及横断位上伤椎骨缺损程度及位置,并进行统计分析。采用汉化Oswestry功能障碍指数(ODI)评估腰背痛症状等。结果:所有病例均获得随访,平均15.5±2.3个月(13~21个月)。三组患者术中出血量无统计学差异(P0.05),但B组的手术时间比A、C两组长,差异具有统计学意义(P0.05);比较三组术前、术后AVH、LKA无统计学差异(P0.05),而末次随访时在AVH、LKA及汉化ODI评分等方面,A组均比B组、C组差(P0.05),B、C两组比较则无统计学差异(P0.05)。末次随访三组患者CT显示伤椎骨缺损在矢状面上主要位于椎体上1/3中部,在横断面上主要位于前柱的中央前缘部。A、B、C三组末次随访伤椎骨缺损程度分别为(18.6±7.3)%、(11.8±4.3)%、(8.4±2.1)%,组间两两比较差异具有显著性(P0.01)。B、C两组无一例出现断钉断棒等现象,而A组则有3例断钉。结论:在后路复位内固定治疗胸腰椎骨折中,与传统短节段内固定相比,结合椎体成形术或经伤椎置钉均能有效维持矫正效果、重建椎体高度及减少内固定并发症,两者临床疗效相当;但经伤椎置钉固定因操作简单、安全,并能进一步有效降低伤椎骨缺损程度,更适合临床推广应用。     

短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折的疗效比较

目的 探讨短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折的临床疗效.方法 回顾性分析自2009-06-2012-06行手术治疗的胸腰椎骨折245例的相关资料.采用短节段经伤椎单侧置钉固定术131例,行短节段经伤椎单侧置钉固定结合椎体内植骨术114例,测量伤椎及其上、下相邻正常椎体的前缘、中间的高度、伤椎后凸Cobb角,比较两组的椎体压缩率、矫正度丢失、术中出血量、手术时间和患者满意度.结果 术后随访18～24个月,平均21.8个月,随访期间椎体高度均无严重丢失,无钉棒弯曲、松动或断裂.伤椎椎体压缩率由术前的(45.59±5.2)％和(46.48±7.5)％降至术后的(8.76±4.8)％和(9.24±4.6)％;后凸Cobb角由术前的(25.8±3.8)°和(24.6±4.2)°降至术后的(9.8±1.7)°和(8.6±2.7)°,两者无明显变化(P＞0.05).2组伤椎中间高度由术前的(56.74±8.6)％和(55.60±7.3)％升至术后的(85.26±10.52)％和(92.52±8.4)％,差异有统计学意义(P＜0.05).结论 短节段经伤椎单侧置钉固定与其结合椎体内植骨治疗胸腰椎骨折均可取得满意治疗效果.     

Surgical outcomes of temporary short-segment instrumentation without augmentation for thoracolumbar burst fractures

BackgroundShort-segment posterior spinal instrumentation for thoracolumbar burst fracture provides superior correction of kyphosis by an indirect reduction technique, but it has a high failure rate. We investigated the clinical and radiological results of temporary short-segment pedicle screw fixation without augmentation performed for thoracolumbar burst fractures with the goal of avoiding treatment failure by waiting to see if anterior reconstruction was necessary.MethodsWe studied 27 consecutive patients with thoracolumbar burst fracture who underwent short-segment posterior instrumentation using ligamentotaxis with Schanz screws and without augmentation. Implants were removed approximately 1 year after surgery. Neurological function, kyphotic deformity, canal compromise, fracture severity, and back pain were evaluated prospectively.ResultsAfter surgery, all patients with neurological deficit had improvement equivalent to at least 1 grade on the American Spinal Injury Association impairment scale and had fracture union. Kyphotic deformity was reduced significantly, and maintenance of the reduced vertebra was successful even without vertebroplasty, regardless of load-sharing classification. Therefore, no patients required additional anterior reconstruction. Postoperative correction loss occurred because of disc degeneration, especially after implant removal. Ten patients had increasing back pain, and there are some correlations between the progression of kyphosis and back pain aggravation.ConclusionTemporary short-segment fixation without augmentation yielded satisfactory results in reduction and maintenance of fractured vertebrae, and maintenance was independent of load-sharing classification. Kyphotic change was caused by loss of disc height mostly after implant removal. Such change might have been inevitable because adjacent endplates can be injured during the original spinal trauma. Kyphotic change after implant removal may thus be a limitation of this surgical procedure.     

Biomechanical analysis of four- versus six-screw constructs for short-segment pedicle screw and rod instrumentation of unstable thoracolumbar fractures

Background contextConventionally, short-segment fusion involves instrumentation of one healthy vertebra above and below the injured vertebra, skipping the injured level. This short-segment construct places less surgical burden on the patient compared with long-segment constructs, but is less stable biomechanically, and thus has resulted in clinical failures. The addition of two screws placed in the fractured vertebral body represents an attempt to improve the construct stiffness without sacrificing the benefits of short-segment fusion.PurposeTo determine the biomechanical differences between four- and six-screw short-segment constructs for the operative management of an unstable L1 fracture.Study designBiomechanical study of instrumentation in vertebral body cadaveric models simulating an L1 axial load injury pattern.MethodsThirteen intact spinal segments from T12 to L2 were prepared from fresh-frozen cadaver spines. An axial load fracture of at least 50% vertebral body height was produced at L1 and then instrumented with pedicle screws. Specimens were evaluated in terms of construct stiffness, motion, and rod strain. Two conditions were tested: a four-screw construct with no screws at the L1 fractured body (4S) and a six-screw construct with screws at all levels (6S). The two groups were compared statistically by paired Student t test.ResultsThe mean stiffness in flexion-extension was increased 31% (p<.03) with the addition of the two pedicle screws in L1. Relative motion in terms of vertical and axial rotations was not significantly different between the two groups. The L1–L2 rod strain was significantly increased in the six-screw construct compared with the four-screw construct (p<.001).ConclusionsIn a cadaveric L1 axial load fracture model, a six-screw construct with screws in the fractured level is more rigid than a four-screw construct that skips the injured vertebral body.     

侧入路微创椎间融合结合后路短节段固定治疗胸腰段骨折的初步临床疗效

【摘要】 目的：探讨侧入路微创椎间融合结合后路短节段椎弓根螺钉内固定治疗累及三柱的胸腰段骨折的初步临床疗效。方法：2009年10月～2012年9月,采用后路短节段椎弓根螺钉内固定结合二期侧入路微创椎间融合技术治疗符合入选标准的累及三柱的胸腰段骨折患者12例,包括男10例,女2例,平均年龄33±9.4岁（21～47岁）。所有患者首先接受后路短节段椎弓根钉内固定,2周后接受侧入路微创椎间融合重建脊柱前中柱稳定性。侧入路微创椎间融合采用自行设计的工作通道,融合节段包括T11/12 4例,T12/L1节段5例,L1/2节段3例。分别记录前后路手术的手术时间、手术出血量及手术相关并发症情况。在术前、术后以及末次随访时分别采用ASIA 2011标准以及Cobb角评价患者神经功能情况以及矫正维持情况。末次随访时采用Suk标准评价植骨融合情况。结果：后路手术时间平均125.8±29.0min,手术出血量平均460.5±88.1ml;侧入路微创椎间融合手术时间平均127.1±21.7min,手术出血量平均185.8±62.3ml。侧入路椎间融合相关手术并发症包括术后穿刺侧血胸1例,穿刺侧神经根损伤1例。随访时间平均12.75±4.6个月。患者术前平均Cobb角31°±8.7°,侧入路椎间融合术后平均Cobb角5.1°±3.5°,随访过程中平均矫正丢失4.3°±2.1°。末次随访时骨性融合8例（66.7%）,可疑融合4例（33.3%）,无植骨不融合及假关节病例;术前不完全损伤者中有5例出现至少1个级别的神经功能提高,其他患者神经功能无改善;无内固定失败病例。结论：侧入路微创椎间融合结合后路短节段固定治疗累及三柱的胸腰段骨折可取得满意的治疗效果,是否可作为传统前后路开放手术的替代或补充有待更多病例更长时间观察。     

Clinical importance of posterior vertebral height loss on plain radiography when conservatively treating osteoporotic vertebral fractures

PurposeTo predict spinal canal compromise, the assessment of plain radiography with magnetic resonance imaging (MRI) can aid the detection of vertebral body collapse and prevent the development of neurological deficits.MethodsPatients who suffered osteoporotic vertebral fractures (OVFs) between January 2012 and December 2014 underwent consecutive radiological assessments, including measurements of anterior height loss (AHL), posterior height loss (PHL), and the kyphotic angle (KA). The fracture morphology was classified by AOSpine thoracolumbar spine injury classification system. MRI was performed at the initial assessment and the extent of canal encroachment (CE) was calculated in all patients. Follow-up computed tomography (CT) or MRI was performed in patients exhibiting significant height loss in follow-up radiography. The fracture patterns in T1- and T2-weighted MRI were also assessed.ResultsA total of 485 patients visited our institute for treatment of OVFs and 97 were enrolled; 15 were male and 82 were female. The mean age at initial visit was 70.3 ± 14.6 years. The initial spinal CE was correlated with the initial PHL and the initial AHL. The follow-up CE was correlated with age, the initial PHL, and the difference between the initial and last PHL (ΔPHL_{(initial-last)}). OVFs with both endplate fractures have a greater tendency of posterior wall collapse than those with single endplate fracture. On initial T1-weighted sagittal MRI, a diffuse low signal change pattern of the fractured vertebra was correlated with PHL. Delayed neurological deficits developed in four patients. These patients underwent surgical intervention.ConclusionsIn patients with simple compression fractures, attention should be paid to the posterior vertebral body and both endplates as well as the T1-weighted MRI findings to allow early detection of spinal canal compromise, which can have devastating consequences.     

单节段与短节段椎弓根钉棒固定手术治疗单节段胸腰段椎体爆裂性骨折疗效的Meta分析

目的 :对单节段与短节段椎弓根钉棒固定手术治疗单节段胸腰段椎体爆裂性骨折的疗效进行Meta分析。方法:计算机检索Pubmed、Embase、Web of Science、Cochrane Library、中国知网全文数据库等数据库,检索的主题词为"单节段(mono-segment pedicle instrumentation,MSPI或monosegmental pedicle instrumentation)"及"爆裂性骨折(burst fracture)",检索自建库起至2018年10月30日时的对照研究文献,语言限定为英文或中文。纳入关于单节段与短节段椎弓根钉棒固定手术治疗单节段胸腰段椎体爆裂性骨折的相关对照研究,患者年龄18岁,随访时间≥1年。对纳入文献进行质量评价,回顾性队列研究使用纽卡斯尔-渥太华量表(NOS),随机对照研究采用物理治疗证据数据库(Physiotherapy Evidence Database,PEDro)量表。利用Stata 12.0统计学软件进行数据分析,根据组间异质性以加权均数差(WMD)合并效应量,并计算其95%置信区间(95%CI),异质性较大者进行敏感性分析和亚组分析辨别其异质性来源。评价指标包括手术时间、术中出血量,术前、术后及末次随访时的视觉模拟评分(VAS)、椎体后凸角和椎体压缩率。结果:经过筛选共纳入6篇文献,其中2篇为随机对照研究,4篇为回顾性队列研究,共390例患者,单节段固定组190例,短节段固定组200例。质量评价提示纳入文献均属于高质量研究,其中4篇回顾性队列研究NOS评分为5～9分、2篇随机对照研究PEDro评分均为8分。单节段固定组的手术时间显著少于短节段固定组(WMD=-23.19,95%CI:-44.63,-1.75,P=0.034),术中出血量无显著性差异(P=0.10)。术前的椎体后凸角、椎体压缩率、VAS评分两组比较无显著性差异(P0.05);术后1周和末次随访时的椎体压缩率两组间无显著性差异(P0.05);椎体后凸角(WMD=0.67,95%CI:-0.48,1.83)和VAS评分(WMD=-0.39,95%CI:-0.60,-0.18)在术后1周时单节段固定组均优于短节段固定组(P=0.001,P0.0001),但在末次随访时两组无显著性差异(P=0.875,P=0.523)。经伤椎置钉的亚组分析表明,相比于跨伤椎固定组(WMD=-0.44,95%CI:-1.02,0.15),经伤椎固定(WMD=0.11,95%CI:-0.28,0.50)可显著改善末次随访时的VAS评分(P=0.006)。纳入文献经漏斗图及Egger′s检验无发表偏倚(P=0.055)。结论:在治疗单节段胸腰段椎体爆裂性骨折时,与短节段椎弓根钉棒固定相比,单节段椎弓根钉棒固定治疗具有手术时间短、术后短期疼痛轻与椎体后凸角度恢复好的优势,在随访1年时两者的临床疗效相当。     

AF系统椎弓根内固定治疗胸腰椎骨折

目的：综合评价ＡＦ椎弓根螺钉内固定系统治疗胸腰椎骨折的效果。方法：回顾分析３２例应用ＡＦ经椎弓根内固定系统治疗的胸腰椎骨折患者手术前后的临床体征、Ｘ线片和ＣＴ。结果：３２例患者椎体前缘高度由术前５８％恢复至９７％，椎体后缘（中柱）高度由术前７６％恢复至９８．７％，Ｃｏｂｂｓ角由术前平均１９．１°恢复至术后１．８°。椎管内移位骨块复位率达９０％。平均随诊２０．５个月，瘫痪恢复按ＡＳＩＡ分级：Ａ级中３例无变化，余２９例均提高１～２级。结论：ＡＦ椎弓根内固定系统能达到精确复位固定及椎管有效减压，是一种治疗胸腰椎骨折的有效方法     

胸腰椎爆裂性骨折中椎间盘完整性对手术疗效的影响

目的 :探讨在采用后路伤椎置钉短节段固定融合或非融合手术治疗胸腰椎爆裂骨折时椎间盘的完整性对临床疗效的影响。方法:回顾性分析2009年2月~2012年5月间我科收治的85例接受后路伤椎置钉短节段固定术的胸腰椎爆裂骨折患者的资料,根据椎间盘是否损伤及是否采用椎间融合术将患者分为4组:椎间盘完整未融合组(A1组)、椎间盘完整融合组(A2组)、椎间盘破坏未融合组(B1组)、椎间盘破坏融合组(B2组)。统计各组患者手术前后的上下邻椎间Cobb角、伤椎椎体前缘高度、伤椎上下相邻椎间隙高度、ODI评分、VAS评分及Denis腰痛分级等指标。结果:患者平均随访时间62.9±12.4个月(43~82个月)。4组患者年龄、性别、损伤节段经统计学比较,差异无统计学意义(P0.05)。4组患者术后均能有效地矫正Cobb角及椎体前缘高度,各组间差异无统计学意义(P0.05)。至末次随访时,A1组患者Cobb角丢失率为(1.5±2.4)%,椎体前缘高度丢失率为(4.9±3.8)%,ODI为9.1±3.6,VAS为0.87±0.50分;A2组分别为(2.1±2.2)%、(4.2±3.4)%、8.4±3.3和0.56±0.76分;B1组分别为(3.6±2.3)%、(7.6±3.1)%、15±4.2和1.64±1.10分;B2组分别为(2.8±1.8)%、(5.8±3.7)%、10.0±3.5和1.16±0.48分。A组内比较:A1与A2组Cobb角、椎体前缘高度丢失率、VAS评分、ODI评分差异无统计学意义(P0.05);B组内比较:B1组Cobb角、椎体前缘高度丢失率、ODI评分值高于B2组,差异有统计学意义(P0.05),B组与A组比较,B1组末次随访时的Cobb角、椎体前缘高度丢失率、ODI评分高于A1组,差异有统计学意义(P0.05);B2组Cobb角丢失度大于A2组,差异有统计学意义(P0.05),其他指标与A2组比较差异无统计学意义(P0.05)。各组间椎间高度丢失的差异无统计学意义(P0.05)。结论:胸腰椎爆裂骨折患者椎间盘的完整性影响手术的临床疗效,对于椎间盘有明显撕裂损伤的患者,需切除受损椎间盘并进行椎间植骨融合。     

经伤椎椎弓根植骨置钉后路复位内固定术治疗胸腰椎骨折

目的:探讨在后路复位内固定术治疗胸腰椎骨折中,经椎弓根伤椎植骨置钉手术的有效性和安全性。方法:选取2007年6月～2009年9月间的胸腰椎单节段骨折患者共75例,30例行经椎弓根伤椎植骨置钉(A组),45例行常规跨伤椎(B组)的后路复位内固定治疗;测量手术前后数字射线摄影(DR)侧位片上的伤椎相邻椎Cobb角、伤椎椎体前缘高度(前高),计算伤椎前高压缩比;测量手术前后CT片上伤椎椎管中矢径和计算椎管侵占率;统计手术时间和术中出血量,观察手术并发症,用Denis疼痛分级评估术后腰痛。结果:伤椎前高压缩比A组术前为59.8%,术后为92.9%;B组术前为57.3%,术后为87.1%。相邻椎Cobb角A组术前为20.2°,术后为8.5°,末次随访时为10.3°;B组术前为22.7°,术后为12.3°,末次随访时为16.7°;椎管侵占率A组术前为37.1%,术后为21.9%;B组术前为34.8%,术后为18.3%;A组平均出血量256ml,手术时间107min,疼痛评估P1 25例,P2 5例,1例脑脊液漏;B组平均出血量236ml,手术时间87min,疼痛评估P1 35例,P2 8例,P3 2例,有1例断钉和2例内固定松动;两组手术时间差异有显著性(P<0.05);术后与末次随访时的椎体压缩比和Cobb角两组间比较差异有显著性(P<0.05),而组内比较A组差异无显著性(P>0.05),B组差异有显著性(P<0.05);在椎管侵占率、手术出血量和并发症以及疼痛评估上,两组比较差异无显著性(P>0.05)。结论:在后路复位内固定术治疗胸腰椎骨折中,经伤椎椎弓根植骨置钉能更好地矫正后凸畸形、重建椎体高度、维持矫正效果和减少内固定的松动断裂等并发症,手术有效且安全。     

Additional vertebral augmentation with posterior instrumentation for unstable thoracolumbar burst fractures

BackgroundTo investigate the role of vertebral augmentation in kyphosis reduction, vertebral fracture union, and correction loss after surgical management of thoracolumbar burst fracture.DesignRetrospective chart and radiographic review.SettingLevel 1 trauma center.MethodsThe analysis included patients treated between April 2007 and June 2015, who received pedicle-screw-rod distraction and reduction within two days following acute traumatic thoracolumbar burst fracture with a load sharing score >6. Medical records were retrospectively reviewed for data regarding operative details, imaging and laboratory findings, neurological function, and functional outcomes.InterventionNot applicable.Main outcome measuresSagittal index, pain score, loss of correction, and implant failure rate.ResultsNineteen patients were enrolled in this study (mean age, 37.2 ± 13 years; age range, 17–62 years; female/male ratio: 10/9). Of the five patients who received only reduction (no augmentation), one underwent revision surgery because of implant failure and pedicle screw backing out. Compared to patients who received only reduction, those who received both reduction and augmentation showed better sagittal alignment after the operation, with better sagittal index immediately postoperatively and during the follow-up (p < 0.05).ConclusionsTranspedicular vertebral augmentation with calcium sulfate/phosphate-based bone cement may reinforce thoracolumbar burst fracture stability, partially restore vertebral body height, and reduce pedicle screw bending and movement, thereby preventing early implant failure and late loss of correction, especially in patients with excellent fracture reduction.Level of evidence: Therapeutic level III, retrospective chart review     

腰椎间隙高度与椎体高度比值的测定及其临床意义

目的测量正常的腰椎X线侧位片,为临床腰椎疾病的诊断及治疗效果评价提供客观标准的依据。方法抽取正常腰椎侧位片380例,测量各椎间隙与上位椎体前、中及后缘的高度,并求得椎间隙与上位椎体高度的比值,进行数据处理。结果男性比值:前缘为0.442~0.607,中份为0.284~0.417,后缘为0.203~0.324。女性比值:前缘为0.440~0.605,中份为0.280~0.414,后缘为0.201~0.321。结论各椎间隙与上位椎体间的比值较恒定。男性较女性的均值稍高,两者间差异无显著性(P<0.05)。