伤椎内球囊扩张植骨治疗胸腰椎爆裂骨折的应用价值研究

目的探讨后路钉棒复位固定联合经椎弓根伤椎内球囊扩张后植骨手术,在胸腰椎爆裂骨折治疗中的应用价值。方法 31例胸腰段及腰椎爆裂骨折,采用后路椎弓根钉棒复位固定,经伤椎椎弓根置入PKP系统球囊,扩大伤椎内骨质空腔,植入人工骨填充的方法进行治疗,并在手术时间、透视次数、植骨量、出血量、椎体前后缘平均高度、Cobb角、椎管占位等方面,与钉棒复位经椎弓根单纯植骨方法做初步对比。结果31例爆裂骨折复位固定良好,神经功能ASIA评分无一例加重,伤椎内植骨区域填充良好,22例患者术后坚持随访,无一例断钉断棒,骨折愈合良好,伤椎内无空腔形成,取出内固定物后6月复查,无一例伤椎塌陷;在手术时间、透视次数、出血量、椎体前后缘平均高度、Cobb角、椎管占位等方面,与经椎弓根单纯植骨手术无明显差异,但植骨量更加充分,有明显的统计学差异(P0.01)。结论本术式治疗胸腰椎爆裂骨折理论上是一种有效手段,但与传统的简单钉棒复位固定方式比较,是否可以明显减少钉棒取出后伤椎塌陷的发生,还需深入研究及大宗病例随访。

The value of bone grafting after transpedicle saccule expanding in treating thoracic and lumbar vertebral burst fractures

Abstract]Objective To value bone grafting after transpedicle saccule expanding in the injured vertebral body combined with pedicle screw internal fixation for treating thoracic and lumbar vertebral burst fractures. Methods 31 cases of thoracic and lumbar vertebral burst fractures were cured with posterior pedicle screws and rods internal fixation, and then, to graft artificial bone after trans-pedicle saccule expanding in the injured vertebral body. All cases were contrasted with the cases without saccule expanding,including:time of operation,X-ray,blood loss,amount of bone graft, average height of anterior and posterior border of vertebral body,cobb angle,occupation of vertebral canal.Results All cases were obtained good reduction and fixation.ASIA grade for nerval function were not reduced.The bone grafted in the vertebral body were sufficient.22 cased were followed up,no break of rod and screw was observed in any case.There were good union of fractures and not void in the vertebral body.The collapse was not found in any case after 6 months since internal fixation was removed.There was no difference between the time of operation,X-ray,blood loss,average height of anterior and posterior border of vertebral body, cobb angle, occupation of vertebral canal compared with the graft artificial bone without saccule expanding group. But, there was significant difference between the amount of bone graft(P <0.01). Conclusion The method should be effective theoretically for treating thoracic and lumbar vertebral burst fractures. But, if there is marked difference between "expanding" with " no expanding" for preventing collapse after rods and screws removed from patient will be researched deeply.