骨盆牵引复位联合单侧入路椎体成形术治疗胸腰椎压缩骨折

目的探讨骨盆牵引复位联合单侧入路椎体成形术治疗胸腰椎压缩性骨折的临床效果。方法 2003年11月～2008年8月对116例受伤3周以内胸腰椎压缩性骨折,先行骨盆牵引复位压缩的椎体,然后再行单侧入路椎体成形术,观察压缩骨折的复位程度、疼痛缓解以及骨水泥渗漏情况。结果 7例椎体周围有少许骨水泥渗出,2例椎管内少量泄漏,2例静脉注入,骨水泥渗漏率9.5%(11/116),均无临床症状,无过敏反应。1例术后短暂发热,经对症处理后缓解。116例随访6个月～5.5年,平均3年6个月,疼痛缓解有效率92.2%(107/116);骨折复位情况:椎体高度恢复60%～95%,平均85.4%;椎管直径恢复情况:90%～100%,平均93.6%。结论骨盆牵引对于急性胸腰椎压缩性骨折有较高的复位率,并能够很好矫正后凸畸形,联合单侧入路椎体成形术,使受伤椎体的强度立即得到加强,具有创伤小、疗效好、并发症少、价格低廉,值得推广应用。

Pelvis Traction Reduction Combined with Lateral Percutaneous Vertebroplasty for Thoracic and Lumbar Vertebral Compression Fracture

Objective To study the clinical effect of pelvis traction reduction and lateral percutaneous vertebroplasty in the treatment of thoracic and lumbar vertebral compression fracture.Methods From November 2003 to August 2008,116 patients with thoracic and lumbar vertebral compression fracture,who had been injured for no more than 3 weeks,received pelvis traction reduction of the injured vertebrae.After the reduction,we performed lateral percutaneous vertebroplasty on the patients.The restoration of the vertebrae,improvement of pain,and bone cement leakage were observed after the operations.Results Bone cement leakage was observed in 11 patients after the operations;7 of them had the cement leaking into the space around the vertebrae,2 into the spinal canal,and the other 2 into the veins,but no patients showed clinical symptoms or allergic reaction.The total rate of cement leakage was 9.5%（11/116）.One patient developed transient fever after the surgery and was cured by conservative treatment.We followed the 116 patients for a mean of 3.5 years（ranged from 0.5 to 5.5 years）.During the follow-up,we found a rate of pain relief of 92.2%（107/116）,and the fractured vertebrae restored by 60%-95% of the original height（mean,85.4%）,while the diameter of the spinal canal restored by 90%-100%（mean,93.6%）.Conclusions Pelvis traction reduction is effective for acute thoracic and lumbar vertebral compression fracture.It can result in a high restoration rate and good outcomes in correcting deformation.Combined with lateral percutaneous vertebroplasty,the injured vertebrae can be strengthened;meanwhile,no large surgical trauma,severe complications,or high hospital cost is generalized.