椎弓根钉系统联合椎体内混合植骨治疗严重胸腰椎压缩、爆裂性骨折

目的探讨采用椎弓根钉系统复位固定联合经椎弓根椎体内骨泥、颗粒骨混合植骨治疗严重胸腰椎压缩、爆裂性骨折的疗效。方法2001年1月-2008年1月对18例严重新鲜胸腰椎骨折先行滑脱、骨折内固定器系统（SF或AF）固定,后经椎弓根向复位椎体内植入自体骨泥、颗粒骨。结果术中无脊髓、神经损伤等并发症,术中出血量50-300 ml,平均80 ml。手术时间100-180 min,平均120 min。术后住院时间12-30 d,平均14 d。18例随访5-72个月,平均24个月,椎体高度和生理弧度恢复满意,无神经症状加重,17例椎体高度和生理弧度无丢失,1例生理弧度部分丢失,无固定松动、断裂。术前脊髓损伤Frankel分级：A级1例,B级1例,C级5例,D级3例,E级8例;术后恢复至B级1例,C级1例,E级16例。结论椎弓根钉系统内固定联合经椎弓根椎体内骨泥、颗粒骨混合植骨治疗严重胸腰椎压缩、爆裂性骨折,手术安全,效果满意。

Transpedicular Fixation Combined with Mixed Transpedicular Structural and Cancellous Bone Graft for Severe Compressed or Burst Thoracolumbar Spinal Fractures

Objective To explore the efficacy of transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft for the treatment of severe compressed or burst thoraeolumbar spinal fractures. Methods From January 2001 to January 2008, 18 cases of severe compressed or burst thoracolumbar spinal fractures was treated with transpedicular fixation of spondylolisthesis and fracture （SF） or atlas fixation （AF） combined with mixed transpedicular structural and cancellous bone granule graft in the compressed vertebral body. Results In this group, no injuries to the spinal cord or nerves occurred. The mean blood loss was 50 -300 ml （average 80 ml）. The mean operation time was 100 - 180 min （mean 120 rain） , and the mean postoperative hospital stay was 12 to 30 days （14 days on average）. Follow-up was available in 18 cases for a mean of 24 months （5 -72 months） , all the patients achieved satisfying recovery of the height and physiological curve of the vertebral body： 17 of the cases had normal height and physiological curve; in the other patient, the natural curve was partly destroyed; no patient had loosing and disrupted internal fixation. According to preoperative Frankel evaluation, 1 case was classified as Frankel A, 1 Frankel B; 5 Frankel C, 3 Frankel D, and 8 Frankel E before the operation ; while postoperative classification showed 1 case of Frankel B ; 1 cases of Frankel C, and 16 cases of Frankel E. Conclusions Transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft is safe and effective for the treatment of severe compressed or burst thoracolumbar spinal fractures.