短节段加伤椎固定结合硫酸钙填充治疗胸腰椎爆裂骨折

The treatment of thoracolumbar burst fracture by using vertebroplasty combined with the fixation of injured vertebra

目的:探讨短节段加伤椎固定结合硫酸钙填充治疗胸腰椎爆裂骨折的临床效果。方法:2005年1月～2008年10月,对91例胸腰椎爆裂骨折患者分别采用短节段加伤椎固定结合硫酸钙椎体成形(A组,32例)、短节段加伤椎固定(B组,29例)和短节段固定结合硫酸钙椎体成形(C组,30例)治疗。所有患者术后至少随访13个月。对三组患者的临床资料(包括术前、术后及末次随访的Cobb角、伤椎前缘高度比值和VAS疼痛评分等)进行比较分析。结果:三组病例在年龄、性别、损伤节段和术前神经功能方面无显著性差异(P>0.05)。随访中有神经功能损害的患者Frankel分级都有1～2级的神经功能恢复。B组手术时间和术中出血量(83.5±15.6min,226.4±28.5ml)比A组(93.5±13.4min,243.4±30.4ml)、C组(90.4±13.3 min,237.4±25.5ml)少(P<0.05)。术前三组椎体前缘高度比值(48.6%±8.1%,47.3%±8.6%,47.9%±7.7%)、Cobb角(28.6°±4.2°,28.8°±5.7°,29.8°±4.5°)比较无显著性差异(P>0.05);术后A组(96.2%±3.2%,5.2°±1.2°)、B组(96.8%±3.5%,5.3°±1.1°)优于C组(94.8%±4.3%,6.3°±1.8°)(P<0.05);末次随访时A组(96.1%±2.6%,5.7°±2.6°)优于B组(93.7%±3.7%,6.8°±3.1°)和C组(94.2%±3.3%,29.8°±4.5°)(P<0.05)。三组丢失的椎体前缘高度、Cobb角比较A组(2.1%±0.1%,1.2°±0.8°)、C组(2.3%±0.1%,1.4°±0.5°)小于B组(5.1%±0.2%,3.7°±1.6°)(P<0.05)。末次随访时VAS评分三组之间无显著性差异(P>0.05)。B组1例螺钉断裂,C组有1例内固定松动移位,A组无内固定失败病例。结论:短节段加伤椎固定结合硫酸钙椎体成形治疗胸腰椎爆裂骨折能够有效恢复并维持伤椎的高度,提供了伤椎前中柱支撑和固定,疗效较好。

Objective：To explore the clinical treatment results for thoracolumbar burst fracture by using vertebroplasty with calcium sulfate cement combined with the fixation of injured vertebra.Method：From January 2005 to December 2008,91 patients with thoracolumbar burst fracture were divided into three groups：group A,32 patients underwent three-level fixation including fractured vertebra using vertebroplasty with injectable calcium sulfate;group B,29 patients were fixed three-level verbebra including injured vertebra;group C,30 cases underwent short-segment fixation combined with injectable calcium sulfate vertebroplasty.The least follow-up time was 13 months.Radiographic parameters and clinical outcomes were compared among 3 groups.Result：The 3 groups were similar in age,sex,fracture levels and preoperative neurologic status distribution.All patients with neurologic deficits were improved at the final follow-up.Operation time and blood loss in group B（83.5±15.6min,226.4±28.5ml） were less than group A（93.5±13.4min,243.4±30.4ml） and group C（90.4±13.3min,237.4±25.5ml）（P〈0.05）.The ratio of anterior vertebral height（48.6%±8.1%,47.3%±8.6%,47.9%±7.7%） and the Cobb angle（28.6°±4.2°,28.8°±5.7°,29.8°±4.5°） had no statistical significance preoperatively（P〉0.05）,but which in group A（96.2%±3.2%,5.2°±1.2°） and group B（96.8%±3.5%,5.3°±1.1°） were better than group C（94.8%±4.3%,6.3°±1.8°） postoperatively.At the last follow-up,the ratio of anterior vertebral height and the Cobb angle in group A（97.1%±2.6%,5.7°±2.6°） were better than group B（93.7%±3.7%,6.8°±3.1°） and group C（94.2%±3.3%,29.8°±4.5°）（P〈0.05）.The loss of ratio of anterior vertebral height and Cobb angle in the group A（2.1%±0.1%,1.2°±0.8°） and group C（2.3%±0.1%,1.4°±0.5°） were less than group B（5.1%±0.2%,3.7°±1.6°） at the follow-up,and the difference was statistical significance（P〈0.05）.The VAS score had no statistical significance among the 3 groups at the final follow-up（P〉0.05）.There was 1 case of broken screws in group B and 1 case of implant failure in group C,while there was no implant failure in group A.Conclusion：The surgery of fixation of fractured vertebra with calcium sulfate cement vertebroplasty is a safe and effective method for the treatment of thoracolumbar burst fracture.It can restore the vertebral mechanical strength,achieve and maintain kyphosis correction,decrease the instrument failure rate and loss of vertebral height.