椎体成形术结合体位复位治疗创伤性胸腰椎骨折

The effectiveness of the combination of postural reduction and vertebroplasty for traumatic thoracolmnbar spine fractures

目的观察在体位复位辅助下椎体成形术治疗创伤性胸腰椎椎体骨折的临床疗效。方法2003年1月至2006年2月，48例新鲜单节段胸腰椎椎体骨折患者，男36例，女12例；年龄24～76岁，平均50岁。其中T11 4例，T12 12例，L1 18例，L2 8例，L3 4例，L4 2例。根据Denis胸腰椎骨折分型：压缩性骨折，B型32例，C型6例，D型8例；爆裂性骨折2例，均为B型。取俯卧位调节手术床使患者椎体骨折部位过伸，达到满意的闭合复位后，经皮双侧椎弓根穿刺充填自固化磷酸钙骨水泥。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度，并计算椎体高度压缩率及恢复率。记录分析视觉模拟评分（VAS）及伤椎形态变化。结果术后随访15～37个月，平均18个月。术后伤椎处疼痛均显著缓解，VAS评分从术前平均（6．9±1．6）分降至术后平均（1．7±0．8）分，椎体前壁高度和中间高度明显恢复，后凸畸形得到矫正。随访期间疗效满意，伤椎高度无明显丢失。结论在严格掌握手术适应证，选择合适病例的前提下，采用体位复位辅助下经皮椎体成形术治疗创伤性胸腰椎椎体骨折，能迅速缓解疼痛，有效恢复椎体高度和矫正后凸畸形。

Objective TO determine the efficacy and feasibility of the combination of postural reduction and percutaneous vertebroplasty for traumatic thoracolumbar spine fractures. Methods Forty-eight consecutive patients with single level traumatic thoracolumbar spine fractures were included in this study. There are 36 males and 12 females, with average age of 50 years （range 24-76 years）. Patients were treated with postural reduction by extending the operating table, then percutaneous bilateral transpedicular reduction of the endplate was performed, and calcium phosphate cement was injected. The results were quantitatively evaluated, according to the concept of estimated vertebral height loss and kyphotic angle of the vertebral fractures by radiographs. Visual analog scale （VAS） and the affected vertebra shape changes were recorded. Results Patients were followed up for 15-37 months （average 18 months）; all patients reported significant alleviation of the pain after treatment. VAS scores was reduced averagely from 6.9±1.6 to 1.7±0.8, the anterior and middle vertebral height was restored and kyphotic abnormality was corrected. During the period of follow up, postoperative outcomes were satisfactory without notable corrected vertebral height loss. Conclusion If the indications are respected, percutaneous vertebroplasty following postural reduction can provide significant pain relief and restore the vertebral height and kyphotic angle in patients with traumatic thoracolumbar spine fractures.