椎弓根螺钉固定结合可注射型人工骨治疗严重腰椎爆裂性骨折

目的 探讨应用椎弓根螺钉固定结合可注射型人工骨(MIIG)治疗严重腰椎爆裂性骨折的临床疗效. 方法 自2002年3月至2004年1月,采用此方法治疗严重腰椎爆裂性骨折患者38例,Denis分型:A型5例,B型16例,c型8例,D型3例,E型6例.观察手术前后后凸畸形、椎体前后缘高度变化、腰背疼痛VAS评分、神经功能分级,并行单因素方差统计分析. 结果 所有患者获得18～36个月(平均26个月)随访.骨折椎体近似解剖复位34例,椎体高度恢复4/5者4例,手术前后Cobb角、椎体前缘高度、腰背疼痛VAS评分手术前、后均存在明显差异(P<0.05),术后均无神经症状加重或出现新的神经症状,未见人工骨灌注后造成椎管渗漏,随着新骨的长入MIIG逐步完全被新骨替代.全部骨性愈合,无断钉、断棒、退钉及松动现象.于术后10～15个月取出内固定,骨折椎体未发生再塌陷,仅2例遗留腰背痛. 结论 严重腰椎爆裂性骨折应用椎弓根螺钉固定结合可注射型人工骨治疗可减少椎体高度、角度丢失及纠正后凸畸形,减轻腰背疼痛,手术安全性高,疗效确切.

Treatment of serious lumbar burst fractures with fixation by vertebral pedicle system combined with minimally-invasive injectable bone graft

Objective To discuss the clinical effects of fixation by vertebral pedicle system combined with minimally-invasive injectable bone graft in the treatment of serious lumbar burst fractures.Methods Thirty-eight patients with serious lumbar burst fractures were treated by vertebral pedicle system combined with minimally-invasive injectable graft.According to the Denis classification,the fractures were diagnosed as type A in 5 cases,type B in 16,type C in 8,type D in 3,and type E in 6.Their preoperative and postoperative plain X-ray films were evaluated.Analysis involved kyphotic angulation,anterior vertebral body height,neural function and back pain.The results were statistically analyzed,with a P value less than 0.05 indicating significant difference. Results All the patients were followed up from 18 months to 36 months(26 months on average).The vertebral heights were regained very well.There were significant differences in Cobb'S angle,anterior vertebral body height and back pain between preoperatively and postoperatively.No patients complained of neurological complications or leakage of the MIIG from the spinal channel.There were no such complications as plate-screw loosening or breaking,or segmental instability.All patients recovered,without notable correction loss or implant failure during the follow-up.Only 2 patients suffered from back pain. Conclusions Treatment of serious lumbar burst fractures with fixation by vertebral pedicle system combined with minimally invasive injectable graft can reduce loss of the vertebral height,correct kyphosis abnormality and relieve back pain.Besides positive curative effects,it is also safe and easy.