椎弓根钉复位内固定结合可注射复合人工骨修复胸腰椎骨折的稳定性

Stability of vertebral pedicle screw system fixation and vertebroplasty for thoracolumbar fractures

背景:胸腰椎骨折后路椎弓根螺钉系统复位后易出现椎体内空壳现象,防止断钉、断杆、螺钉松动、弯曲、Cobb角增加及后期椎体高度丢失等并发症是近年来脊柱外科研究的热点之一。目的:观察椎弓根钉系统复位内固定结合可注射型复合人工骨椎体成形修复胸腰椎骨折的效果。设计、时间及地点:回顾性病例分析,于2005-06/2006-12在深圳市龙岗中心医院骨科进行。对象:胸腰椎骨折患者l7例,男11例,女6例,平均年龄38.2岁。损伤节段:T112例,T125例,L17例,L23例。压缩性骨折9例,爆裂性骨折8例。合并有神经损伤13例。方法:采用椎弓根钉棒系统对伤椎进行复位后通过伤椎椎弓根注入复合人工骨行椎体成形治疗,治疗前后行X射线摄片和CT检查并随访。主要观察指标:①材料与宿主的生物相容性反应。②人工骨吸收情况。③伤椎椎体前缘高度、后凸Cobb角。结果:17例患者均获随访,随访大于10个月。①随访期内无内固定材料松动及断裂现象,椎体高度恢复满意,无再塌陷,人工骨椎体内充填满意,1例发生椎管漏。②CT显示注入椎体内的人工骨均在4个月内吸收。③治疗后伤椎压缩程度和后凸畸形Cobb角明显小于治疗前[(9.79±3.23)%,(51.28±8.67)%,P<0.01;(5.6±3.8)°,(23.4±7.6)°,P<0.01]。结论:采用椎弓根螺钉系统复位内固定及可注射人工骨椎体成形治疗胸腰椎骨折解决了椎体内的空壳问题,减少了修复后并发症的发生,提高了脊柱的稳定性。

BACKGROUND： Vertebral ghost, screw breakage, rod breakage, screw loosening and bending, increase in Cobb angle and anterior height loss are complications after pedicle screw system fixation for treating thoracolumbar fracture. OBJECTIVE： To explore the effect of vertebral pedicle screw system and vertebroplasty by filling the injured vertebrae with injectable artificial bones on thoracolumbar fractures. DESIGN, TIME AND SETTING： The retrospectively analysis was performed at Department of Orthopedics, Shenzhen Longgang Central Hospital from June 2005 to December 2006. PARTICIPANTS： Seventeen patients with thoracolumbar fractures were selected, including 11 male and 6 female with an average of 38.2 years. The fractures involved 2 cases of T11, 5 of T12, 7 of LI, and 3 of L2, 9 of compression fracture and 8 of blowout fracture. In addition, 13 cases were complicated by nerve injury. METHODS： The patients were treated with vertebral pedicle screw system internal fixation and vertebroplasty by filling the injured vertebrae with injectable artificial bones. Radiographic and CT examinations were performed before and after surgery, and the patients were followed up postoperatively. MAIN OUTCOME MEASURES： Biocompatibility of materials to host; resorption of artificial bone; the anterior height and improved Cobb angle of the injured vertebrae body postoperatively. RESULTS： Seventeen patients were followed up for more than 10 months. During the following-up, no case showed internal fixation device loosening or breakage; No case had anterior height loss of body of spine or collapse. The filling in artificial bone was favorable and only 1 case developed spinal canal leakage. CT results showed all injected artificial bones were absorbed within 4 months postoperatively. The anterior height and Cobb angle of the injured vertebrae body were significantly less than before treatment [（9.79 ± 3.23 ）%, （51.28 ± 8.67 ）%, P 〈 0.01 ; （5.6 ± 3.8）°, （23.4 ± 7.6）°, P 〈 0.01 ]. CONCLUSION： Fixation with vertebral pedicle screw system and vertebroplasty using injectable artificial bones avoids hollow vertebrae, reduces complication after surgery and improves stability of spine.