人工骨椎体成形术治疗胸腰椎爆裂骨折

目的:探讨经椎弓根人工骨植入椎体成形术治疗胸腰椎爆裂性骨折的方法和效果。方法:胸腰椎爆裂骨折12例,男8例,女4例;年龄28～61岁,平均47.5岁;受伤时间4～12d;术前Frankel分级:C级1例,D级3例,E级8例;受伤椎体:T112例,T122例,L15例,L23例;术前后突角11°～35°,平均24°;术前椎管占位率39%～85%,平均64.5%;术前伤椎椎体前缘高度平均为正常的47%。行后路切开复位短节段椎弓根钉内固定后,人工骨经伤椎椎弓根植入椎体成形术。结果:所有患者均获随访,时间3～19个月,平均13个月。脊柱后突角平均恢复20°,椎体高度平均恢复96%,椎管占位率平均恢复至7%。2例人工骨椎体内充填不足;无内固定松动、断裂、椎体高度变低及生理弧度丢失。神经功能恢复:1例术前Frankel分级C级及2例D级患者术后均恢复至E级。结论:经椎弓根人工骨植入椎体成形术重建了椎体高度,增加了脊椎前柱的抗压稳定性,使患者能早期活动,减少内固定物因应力过大造成的断钉、松动、椎体再压缩等并发症。

Treatment of thoracolumbar vertebral fracture by filling the injuried vertebrae with artificial bones

Objective:To study the method and effect for treatment of thoracolambar vertebral burst fracture by filling the injuried vertebrae with artificial bones.Methods:Twelve patients of thoracolumbar burst fracture included 8 male and 4 female;The average age was 47.5 years ranging from 28 to 61 years;The injuried time was from 4 to 12 days.According to Frankel degree,1 case was in grade C,3 cases were in grade D,3 cases were in grade E.The injuried vertebral body of 2 cases were in T_11,2 cases in T_12,5cases in L₁,3 cases in L₂.In preoperation,posterior process angle was from 11° to 35°,mean 24°;Spinal canal occupational ratio was from 39% to 85%,mean 64.5%;The average height of anterior vertebral border was 47% of normal.After open reduction and fixation with short-segment pedicle instrumentation through posterior approach,the artificial bone were filled in the pedicle to reconstruct the vertebra.Results:All patients were followed up for from 3 to 19 months,mean 13 months.The posterior process angle recovered 20°in average,the height of vertebra recovered 96%,the spinal canal occupational ratio recovered to 7%.The artificial bone filled were not enough in 2 cases.Looseness and breakage of the internal fixation,loss of the normal spine curve and the spinal height of the injuried vertebrae were not found.A case of grade C and 2 cases of grade D recovered to grade E.Conclusion:The transpedicular bone grafting plasty can reconstruct vertebral height and increase the stability of the spine and reduce the breaking of nails and other complications.