椎体成形术在胸腰椎骨折中的应用

The Application of Vertebroplasty in the Treatment of Thoracolumbar Fractures

目的：采用椎体成形术治疗胸腰椎骨折，并探讨其并发症发生情况。方法：对31例胸腰椎骨折患者采用钉棒系统椎弓根钉结合自体骨（取自咬下的椎板、棘突及后侧髂骨）和（或）羟基磷灰石人工骨骨粒植入伤椎的椎体成形术。结果：本组31例，26例获得随防，随访时间6-30个月，平均15．6个月，术后3个月神经功能恢复正常E级10例，有神经损伤者3例A级和2例B级患者无恢复，其余术后Frankel分级都有一级以上的好转，无神经损伤者未出现损伤症状。术后卧床时间6—8周，戴腰围下地行走时间为术后10～12周，术后1—2年去除内固定12例，术后6个月X线检查骨折多已愈合，未见弯钉、钉松动、断钉、伤椎再塌陷及植骨失败等并发症的发生。结论：自体骨（取自咬下的椎板、棘突及后侧髂骨）和（或）羟基磷灰石人工骨骨粒椎体成形术取材容易、方法简单，填充确实、组织相容性好，对周围组织无不良反应，对预防胸腰椎骨折术后并发症的发生疗效满意。

Objective：To explore the effect and complication of vertebroplasty in the treatment of thoraeolumbar fractures. Method： 31 patients suffering from tboracolumbar fractures were treated by the pedicle screw system,and vertebroplasty with autogenous bones （from the bited vertebral plate, spinous process and the posterior ilium）or （and） hydroxyapatite artifical bones, by transpedieular approach. Result： 26 cases were followed up for 6 - 30 months （ mean 15.6 months）. After 3 months, Frankle E recovery of neural function were achieved. 3 cases Frankle A and 2 cases Frankle B damaged had no recovery, the others gained 1 - 2 Frankle grades recovery of neural function. All patients had not occurred new nerve injury symptom. 6 - 8 weeks lay in bed, 10 - 12 weeks later got up with waist protection,12 cases unfixed the internal fixation 1 -2 years later after the surgery. All patients were checked with X-ray 6 months later after operation. No complications occurred, such as pedicle screw bended, loosened, broke, the fracture vertebra sunk again and the implanted bones defeated. Conclusion： V ertebroplasty with autogenous bones（from the bited vertebral plate,spinousprocess and the posterior ilium）or（and） hydroxyapatite artifical bones, by transpedicular approach, have the advantages of obtaining the materials easily, being simple, reliablly filling the fracture vertebra, with good histooompatibility, no toxicity and adverse, and have a good effect to prevent the complication.