经皮椎弓根螺钉固定联合伤椎可注射人工骨充填治疗胸腰椎骨折23例

目的探讨经皮椎弓根螺钉系统配合伤椎可注射人工骨充填治疗胸腰椎骨折的可行性及有效性。方法选取2008年1月~2011年12月收治无神经症状的胸腰椎爆裂性骨折﹙T12∕L1﹚23例,采用经皮椎弓根螺钉系统联合伤椎可注射用人工骨填充治疗,随访近期效果。结果手术时间70~90分钟,平均80分钟。术中失血量50~100ml,平均72ml。术后住院时间7~10天,平均8天。随访3~5月,平均3.5月。随访过程中没有患者出现内固定物松动断裂,椎体高度塌陷。随访腰椎CT显示椎体内注入的人工骨边缘模糊,融合良好,无骨吸收现象。伤椎椎体高度维持良好。病椎前缘压缩程度和后凸Cobb角度改变,23例术前伤椎前缘压缩程度为﹙53.41±7.35﹚%,后凸畸形Cobb角为22.72±5.6°。术后伤椎压缩程度为10.78±4.53°,与术前比较差异有统计学意义﹙<0.01﹚,术后后凸cobb角为8.6±3.9°。与术前比较差异有统计学意义﹙<0.01﹚。结论经皮椎弓根螺钉系统配合伤椎可注射人工骨充填治疗胸腰椎骨折可获得良好的近期临床效果,是一种安全有效的微创手术方法。

Minimally invasive percutaneous pedicle screws osteosynthesis (MIPPSO)and vertebroplasty by filling the injured vertebrae with injectable artificial bones on thoracolumbar fractures

Object To explore the feasibility and efficiency of treatment of minimally invasive percutaneous pedicle screws osteosynthesis（MIPPSO） and vertebroplasty by filling the injured vertebrae with injectable artificial bones on tboracolumbar fractures. Methods From Feb 2008 to Sep 2011, 10 patients were treated with MIPPSO and vertebroplasty by filling the injured vertebrae with injectable artificial bones on tboracolumbar fractures. Results The average operative time was 80 minutes （ range, 70-90min 7, with a mean blood loss of 72m1（ range, 504100ml ）and mean postoperative hos- pital stay of 8 days （ range, 7-10 days 7. 23 cases were followed up 3-5 months （ average 3.5 months 7, During the follow- ing-up, no case showed internal fixation device loosening or breakage; No case had anterior height los s of body of spine or collapse. CT results showed all injected artificial bones were absorbed within 3-4 months postoperatively. The anterior height and Cobb angle of the injured vertebrae body were significantly less than before treatment（ 10.78~4.53 7%, （ 53.41±7.35 ）%, P〈0.01; 8.6±3.9°, 22.72±5.6°, P〈0.01]. Conclusion Fixation with vertebral pedicle screw system and vertebroplasty using injectable artificial bones is a safe and effective minimally invasivesurgical method.